Medical claims software automates the capture, validation, and submission of insurance claims. It helps increase processing speed, reduce administrative work, and improve accuracy, which leads to faster reimbursements.
Unlike manual billing tools, medical claims processing software uses OCR technology to extract data automatically from forms like CMS-1500 and UB-04. This reduces the need for manual input and improves operational efficiency.
You should look for high OCR accuracy, EHR integration, HIPAA compliance, real-time validation, and automation of routine billing tasks. Our platform includes all of these to support your revenue cycle.
Automating medical claims processing reduces operational costs by up to 70% compared to manual keying. While human data entry averages 5-10 minutes per complex UB-04 form, Intelligent Document Processing (IDP) extracts and validates the same data in under 60 seconds. This efficiency enables healthcare organizations to scale volume without adding headcount, typically achieving ROI in 3 to 6 months.
It reduces manual errors, checks for missing or invalid data, and ensures compliance with payer rules. This increases first-pass acceptance rates and helps reduce delays or denials.
Yes, OCR Solutions processes UB-04 and CMS-1500 forms using fixed-coordinate template definitions rather than generic text recognition. This approach achieves 99% accuracy on field-specific data like NPI numbers and ICD-10 codes. Integrated logic engines automatically validate line-item math and provider data against external registries, ensuring claim integrity prior to adjudication.
Yes. The software is built to scale and works well for small practices and large billing services. It can process a high volume of claims quickly and securely.
Yes. Our software integrates with most EHR systems, billing platforms, and clearinghouses. It supports custom workflows so you can continue using your existing tools.
No. You can eliminate manual pre-sorting entirely. The system utilizes intelligent document classification to automatically identify and separate UB-04s (CMS-1450) from CMS-1500s within a single mixed batch. It also intelligently detects attachments (medical records, EOBs) and keeps them logically linked to the parent claim throughout the lifecycle. This "single stream" ingestion replaces the need for physical separator pages or manual mailroom sorting, allowing you to scan everything into a single "hot folder" for immediate processing.
OCR Solutions utilizes proprietary image pre-processing algorithms specifically tuned for medical claims. This includes automated "despeckling" to remove the "salt and pepper" noise common in fax transmissions and "deskewing" to straighten images scanned at an angle. Crucially, we employ "Red Dropout" technology which electronically removes the red background grid of the form, isolating the black user data. This allows the engine to capture clean data even from low-quality, 200 DPI black-and-white inputs that would typically fail in standard OCR engines.
Yes. The system is designed to be "destination agnostic." We can map extracted data directly to the API endpoints of major platforms like Cognizant Q Next , or push structured data into your internal SQL databases, Oracle systems, or FTP folders. For proprietary systems, we support custom export formats including JSON, XML, CSV, and standard EDI 837 files. This flexibility allows us to match your existing field headers exactly, ensuring data flows into your adjudication workflow without requiring middleware.
Yes. Beyond standard OCR, the system functions as a logic engine. We can configure "Anchors" (such as Name + DOB) to query your external SQL database or member eligibility API in real-time. If a match is found, the system can auto-populate missing fields or validate that a patient (or inmate) was eligible/in-custody at the time of service. This "external truth" validation prevents invalid claims from ever reaching your payment system, filtering them into a separate exception queue for review.
Yes. For organizations with distributed teams or those wishing to eliminate mailroom logistics, we partner with specialized, US-based scanning bureaus. These partners operate strictly within HIPAA-compliant environments to receive your physical PO Box mail, open, prep, and scan documents directly into the OCR Solutions workflow. This allows your remote staff to log in and begin verifying digital claims immediately, effectively outsourcing the entire physical "paper to pixel" logistical burden.
Red dropout is a specialized optical character recognition technique that eliminates the red background grid found on standard medical forms like the CMS-1500. By "dropping" the background color during the scan, the engine isolates the black handwritten or typed data, removing noise interference. This increases character recognition accuracy to over 99% on structured forms.
Yes, cloud OCR is HIPAA compliant when deployed on SOC 2 Type II certified infrastructure. OCR Solutions secures Protected Health Information (PHI) using end-to-end encryption during transmission and processing. We execute comprehensive Business Associate Agreements (BAAs) and implement strict data retention policies, ensuring patient data is processed securely without unauthorized permanent storage.
We offer full deployment flexibility to meet strict security policies. While we provide a SOC 2 Type II compliant cloud hosting environment , we can also license the software for a fully on-premise installation. This includes "air-gapped" environments where the system runs entirely on your local infrastructure without requiring external internet access. The code base and feature set—including the verification station and admin tools—are identical regardless of whether you choose a hosted or on-prem deployment model.
A typical implementation for a mid-to-large volume deployment takes approximately 3 to 4 months to reach full maturity. This includes an initial 2-3 week period for gathering requirements and installation , followed by a "walking" phase (approx. 1.5 months) where your team gets familiar with the verification station. The final phase involves fine-tuning custom rules and database integrations to reach "sprinting" speed. For urgent needs, we can often get a baseline system functional in as little as 30 days.
The standard engine is optimized for machine-printed text and "clean" handwriting (structured block letters), which covers the vast majority of claims. For workflows with significant volumes of messy or unstructured handwriting, we can integrate specialized third-party intelligent character recognition (ICR) engines, such as Amazon's Textract, directly into the pipeline. This allows you to handle hybrid forms seamlessly, though we typically advise evaluating your specific volume of handwritten claims during discovery to determine if the additional engine cost yields a positive ROI.
Yes. The system includes a comprehensive "Monitoring Station" that acts as your command center. It provides real-time visibility into every batch status (e.g., "Recognizing," "Verification," "Exported") and logs every user action for audit trails. You can track individual verifier productivity, identify bottlenecks, and generate reports on field-level accuracy. If you need specific custom metrics, the reporting module is flexible enough to build tailored views to match your operational KPIs.
We provide a dedicated 40-person help desk available 24/5 to support your operations. Support is not limited to just email tickets; you can call and speak directly to a specialist who knows the system inside out. Because these are mission-critical "living, breathing systems," our support team is trained to resolve 90% of issues immediately without escalation, ensuring your claims production line never stops due to technical blockers.