Data Capture from Medical Insurance Claims

by | Mar 14, 2019


The Importance of Digitization and Data Capture

A medical history of an individual can be compared to a story. Every symptom, illness, onset, medication, diagnoses, and past treatment plans can be indicators for current health and even predict future. For every addition to a person’s medical record, a medical insurance claim is sure to follow.

Claims are incredibly important to both insurers and consumers, but has long served as a sour point for both. Consumers expect clear communications and fast resolutions while insurers are looking for accurate and efficient ways to eliminate the risk of fraud or litigation. When the claim process fails, consumer satisfaction falls and costs of insurance go up. Digitization and data capture has been a key factor in reducing issues for all parties.

Data Capture Improves Customer Service

Delays are common when it comes to medical insurance claims, and are notorious for tarnishing the experience of a customer. Payments that are delayed create unnecessary stress and have the potential to deteriorate the faith in an organization’s customer service. Many of these delays can arise from inaccurate information in claims, lost forms, and even simply a backlog of claims that need to be processed.

Digitization and data capture through Optical Character Resolution (OCR) can help resolve sources of delay.  All forms can be scanned into searchable PDF documents, where cataloging and indexing can happen autonomously based on selected information in forms or form type. Data captured from the CMS 1500 or UB04 forms can now be classified, verified for low confidence characters and vetted through advanced business rules that are pre-programmed into the OCR software. Staff workload and processing time can be reduced by eliminating time spent on manual re-keying.

Reduce Costs, Improve Speed

The automation of processing through OCR allows an organization to take a volume-based approach to medical insurance claims. This has a direct impact when it comes to increasing business productivity as well as reducing costs. Digitization and OCR allows you to take a bulk-processing approach to medical claims vs. traditional scanning/manual re-keying of data. All those forms can be ingested and put in one folder that is monitored my our system. The system ingests the claims and auto classifies them in the system.

With digitization and OCR, data can be automatically extracted, verified, and delivered to whatever claims management system may be in use. Extracted data can be validated through cross field comparisons, customer-specific rules, and even mathematical calculations to drastically improve accuracy while also reducing the need for manual processing.

Improve Security

In a traditional setting, there might only exist one copy of a critical document. They may be centrally stored and rely on physical security such as door and cabinet locks for protection. They can be vulnerable to theft, destruction, and even human error (misfiling or misplacement of forms).

Documents that are made electronic and sorted through automations are not as prone to human error, and they can be backed up onto multiple systems. More importantly, they can be encrypted using the strongest algorithms available to secure data in transit as well as at rest. This is incredibly important when it comes to HIPAA compliance and the reduction or elimination of violations.

Accuracy Where it Matters Most

Perhaps the most important topic when it comes to medical claims is accuracy. Any wrong information processed or filed can subject an organization to HIPAA violations, or even litigation. When manual processing is used for medical claims, information can be mis-keyed or even misinterpreted.

Because digitization and automation takes much of the human element out of the equation, human error is less likely to happen. Staff that might have been previously processing and sorting data manually can shift focus to quality assurance and accuracy along the claim processing chain.

Contact Us Today!

OCR Solutions is an industry-leading expert in Character Recognition solutions and technology. Our goal is to modernize your firm or business, allowing you to shift the focus back on enhancing patient care and customer service. If you have any questions, please do not hesitate to contact us!