Case Study: Medical Claims

Problem

EBC is headquartered in Milwaukee, Wisconsin – with five operations centers located around the country. Their primary goals were to centralize their front-end work and reduce costs – through a data-capture partner and an EDI scrubbing package. A secondary goal was to integrate an enterprise-wide content management software system. .

Solution

First: OnCourse provided a front-end solution that centralized the mailroom, sorting, scanning and data capture through our office – easing staffing and training issues and eliminating the need for multiple-location scanning equipment. Capacity has been increased, and costs have been reduced. After claims have been keyed, data file is transmitted to EBC via Secure FTP.

Second: ValiData – our software partner – installed a data-scrubbing package to pre-process the EDI. Claims data is now run through a robust matching and validation process that significantly increases auto adjudication rates.

Third: Scanned claims are uploaded to the FileBound Content Management Software – providing web access to the claims for all offices.

All back-up requirements have been met, and SAS70 certification has been achieved.

Outcomes

• The front end process is simplified
• Centralized mail processing provides greater consistency
• Scanning and Data Capture are consistently completed in 24-48 hours
• Pre-processing software increased matching and auto adjudication rates
• All claims are processed with the same rules
• FileBound ASP enables access to the claim images from anywhere
• FileBound provides solutions for projects other than claims (W9's, checks, etc.)

Process Overview

• Claims mail is forwarded to OnCourse
• Claims are opened, sorted and scanned within 4 hours
• Data Capture is performed and output in ECSIF or ANSI 837 4010
• EDI is processed with ValiData prior to importing into QicLink
• Claim images are indexed and uploaded to FileBound ASP
• Claims Data is sent to EBC and preprocessed with ValiData software

Advantages

• Reduced costs
• All claims for all offices are processed timely and consistently
• Productivity and efficiency is greatly improved
• No additional hardware is required to support the FileBound software
• Labor savings and reduced training