Insurance Case Study # 1

Business Description:
A major healthcare insurer with offices across the United States that provide insurance coverage and claims processing.

Business Problem:
A branch office located in New England was looking for an electronic document management system to handle the daily processing of all of its incoming claims associated with the Suspense Reconciliation Group. The suspense group is responsible for reconciling claims routed to them to determine eligibility for payment. The current work process to reconcile a claim is very paper intensive, involving the need to retrieve the physical folder containing the claim form and attachments, routing it to the suspense clerk working on it, examining each document and then refiling it. The paperwork involved in this workflow includes forms for:

Universal Billing;
Health Care Financial Administration; and
Dental.
The number of suspense items (paper and tape) generated corporate-wide ranged from 18,000 to 25,000 daily, for an average of approximately 21,979 on a daily basis. There are approximately 13,000 paper claims scanned on a daily basis, with the number of corporate-wide requests for "copy of claim" retrievals averaging 785 daily.

OpenDOX Solution:
Image Architects integrated the forms and corresponding index information, captured by BancTec high-speed scanners, into OpenDOX via an Attachmate 3270 emulation.
Selected data OCR'd in the scanning process was scraped into labeled OpenDOX indexes, facilitating the search and retrieval processes and vastly improving the response time for information gathering and the processing of "copy of claim" requests.
The OpenDOX software provides the ability to store images, along with their corresponding index fields (magnetically), allowing searches and retrievals on an enterprise-wide basis.

Key Benefits:
Saves the time spent retrieving a file from several hours or days to a matter of seconds, allowing for immediate responses to customer and management queries.
Eliminates delays due to paper claims and/or attachments being misplaced or lost were eliminated.
The option to also store images optically is built in to the standard OpenDOX software.

Special Features:

Attachmate 3270 emulation allowing mainframe to OpenDOX connectivity.
Forms overlay feature for ease of data identification (for viewing, printing, and faxing).