Htc Helps The Dept. Of Social And Health Services Fast-track Claims Processing

With the IDEAS OCR Solution, the client achieved more than 300% productivity gain in claim forms management, leaving no daily backlogs.

THE CLIENT

The Department of Social and Health Services (DSHS) that administers two government health insurance programs (Medicare and Medicaid) for different states in the U.S. The government pays for the healthcare expenses of eligible candidates. Medicare is for people aged 65 and over, some people under the age of 65 with disabilities, and those of any age living with permanent kidney failure. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administrated by the states according to federal requirements. It is funded jointly by states and the federal government.

THE CHALLENGE

Speed is a vital factor in claim processing. The client had difficulties to process complex, structured data, which blocked their efforts to automate. This led to daily backlogs and failure to meet SLAs for processing each claim form. The daily backlog was about 800 forms as the client had 24 users processing 1650 forms on an average per day while the average incoming daily volume was around 2500.

The client was extremely dissatisfied with their existing claims management system that posed a challenge to information extraction since the accuracy of the extracted data was extremely low, and the system was plagued by technical and process inefficiencies. The issues were so acute that the client was even considering going back to a manual data entry system for better efficiency. The client contracted HTC. We agreed to take care of the imaging and data capture of their medical claim forms with our Optical Character Recognition (OCR) solution – IDEAS