Streamline and accelerate your medical claims processing with Kofax!
Health care spending in the US is set to increase to $3 trillion in 2011. For health insurers this means:
- More claims to process. Currently 1.5 billion claims are processed each month, equivalent to 75 million per day. Many of these still arrive on paper.
- Increased expenditure and reduced profitability. As the cost of health care in the US rises, insurers need to reduce operating costs, particularly in the area of data entry for claims.
While health insurers may invest in electronic adjudication systems, manual data entry of paper CMS-1500 and UB-04 claim forms is still a major bottleneck. For large hospitals and clinics, electronic data transmission using EDI based on the HIPAA 837 standard is an option, but this is cost-prohibitive for the majority of smaller health care providers.
Insurers also face a challenge in driving out costly payment errors. According to the Healthcare Billing and Management Association (HBMA Edition, July 2007), “The frequency of overpayments, rejections and denials often reaches 50%, mainly due to manual data entry errors and the high complexity of claims.”
The solution is to automate medical claims processing with Kofax.
Kofax enables health insurers to automate their end-to-end medical claims process, efficiently capturing information from CMS-1500 and UB-04 paper claim forms, and reducing operational costs and the frequency of payment errors during data entry.
Benefits at a glance
- Automatic and rapid capture of CMS-1500 and UB-04 paper claim forms and supporting documents, and delivery of that information to business systems and content repositories, replacing expensive manual processes for managing high volumes of documents from a wide variety of sources.
- Enhanced imaging of any scanned claim form or supporting document, irrespective of color, size, weight, contrast, condition or content; consistent, high quality images with minimal user training; and increased efficiency and accuracy of downstream classification and recognition processes.
- Automatic classification, information extraction and validation of CMS-1500 and UB-04 claim forms and supporting documents using self-learning OCR technologies that provide the highest accuracy levels with the most rapid payback, replacing error prone manual processes for extracting and validating information.
- Extensive data validation based on American Medical Association (AMA) certified specifications and databases, reducing exceptions caused by data errors, which are costly to fix “after the fact” and cause incorrect payments.
Learn More: Read Pan American Case Study 
