Case Study: A Cure For The Common Paper Trail Problem

The company was processing up to 20,000 total documents per day and had been using a scanning system since the early 1990s that had the ability to process only one-third of the 12,000 claims received daily. Another third was processed manually, and the remaining work was outsourced.

The mail room was overflowing with paper. “At the time that we looked into imaging, the company was microfilming all of the documents for archiving,” said Ed Davis, director of support operations for Blue Cross Blue Shield. “We would have to route [to the satellite offices] prints off of microfilm, and that would take several days.”

ANATOMY OF A SOLUTION >> COMPANY: Cutting Edge Solutions
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>> PROBLEM and SOLUTION: Blue Cross Blue Shield of Arizona needed to automate the data entry of incoming health-care claims as well as have a standard method of capturing the images and information off all incoming documents.
>> PRODUCTS and SERVICES USED: Datacap Taskmaster for Medical Claims, Kodak 9520 scanners, FileNet Panagon Image Services and FileNet Visual Workflow
>> LESSONS LEARNED: To ensure that a claim will make it through the system, thorough business rules must be in place during the data-capture workflow process. Dynamic recognition enabled Datacap&'s software to adapt to the various ways people fill out forms. Employees at the insurance company had to understand the new digital technology to adjust to the new system.

Objectives for Blue Cross included reducing training time for employees and clients, developing a single point of entry for paper claims, eliminating the handling and storage of paper, improving the accuracy of data entry and developing customer service efficiency.

The insurance company needed a solution that would be able to scan a variety of forms while saving employees time spent making corrections and searching for data. Blue Cross Blue Shield put the project out to bid and chose Cutting Edge Solutions, Kansas City, Mo.

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Cutting Edge created a system for the insurance company that integrated Kodak scanners, a FileNet document management system and Datacap&'s Taskmaster for Medical Claims digital imaging software, designed for the health-care insurance industry.

The software is programmed to gather information from the forms using optical character recognition, and then enters it into the database. The entry operator verifies the information and the claim is sent through the system. For Cutting Edge, one of the biggest obstacles in creating a solution was human error. “The whole project was a challenge,” said Jack Roberts, co-founder of Cutting Edge. “When you go into reading data, and if you&'re going to read it off of a form, it&'s easy because you know where it&'s at. When you have data that is going to float, people are using their own format in different fields.”

Datacap&'s software uses dynamic recognition to process information written on forms, which Roberts said allows the software to adapt to the various ways people choose to fill out forms. Hyphens, colored ink on printed-out documents and sloppy writing have the potential to cause problems. “Little things like that are ‘gotchas,&' which you don&'t expect when you first put it all together,” Roberts said.

The insurance company also needed to adjust to its new system. “One of the biggest challenges that we had in the beginning was having our own staff understand the technology, but that came along quite well and there isn&'t anyone that I know of at Blue Cross who would ever want to go back,” Davis said.

“Within just a few months, [we] had improved the claims entry efficiency by about 30 percent. At the same time, we were increasing the number of edits and checks [because data-entry personnel spent less time entering data]. We&'re adding more work onto the staff that was doing data entry, [who were] able to achieve a 30 percent increase in productivity,” Davis said.

Customer service representatives no longer have to search for a paper document when handling a call concerning a claim, and can pull up the information digitally. Training time for data-entry personnel also has decreased from six weeks to a few days, he said.

For solution provider Cutting Edge, the key to winning Blue Cross&' business was figuring out how to meet the insurance company&'s specific needs. “What kind of documents are they trying to deal with? What are they trying to automate? Is it data entry or is it workflow process? What is the ultimate goal?” Roberts said.