How to Improve Your Claims Processing Accuracy

While the majority of insurance claims are now processed electronically, there is still a significant amount of paper involved in claims processing. As many as 25 percent of claims arrive as physical documents.

Many insurers have implemented document scanning processes, but unfortunately, they do not take full advantage of digital transformation processes. These scanning departments rely heavily on manual labor, slowing claims processing to a crawl: employees have to open the mail, sort documents based on type, date-stamp the forms, insert relevant patch sheets and attach smaller documents to standard-sized sheets. This is why many of these firms wait until the end of the claims process to scan their documents, and typically for archival purposes only.

As seen in most of these workflows, the more human labor that is introduced to a process, the higher the risk of error. Added hand-offs, multiple touches all contribute to mistakes being made.  Once the work is done, the documents then need to be indexed and filed accordingly.  

Fortunately, there are intelligent document imaging solutions that not only reduce labor and minimize error but also enable more efficient and economical claims processing.

The Problem with Difficult Documents

Claims documents often need to be copied or shared and reviewed by multiple departments, depending on the type of claim. Handling physical documents makes it difficult for numerous employees to work on the same claim simultaneously.  Data from various documents within a claim is manually entered into the claims management software. These steps can lead to errors or omissions that create turmoil in the process, delay payments or result in mishandling of the claim.  For instance, health insurance claims files are subject to HIPAA privacy guidelines, which means that even incorrectly handling documents may result in a compliance violation. 

By utilizing an automated one-touch mailroom process and advanced document management software as soon as claims enter the organization, claims forms can be scanned, edited, categorized, tagged and sorted.  Applying optical character recognition (OCR) technology can aid in automatically reading, classifying and distributing claims documents, saving a tremendous amount of manual data entry. Insurers can also ensure that complete and correct documents are routed to only those employees who need to work those claims. 

Document Variety Poses a Challenge

Claims documentation comes in various sizes and formats. In some cases, they include photographs, X-rays, and other “non-scannable” items. In the past, the variability of these documents made scanning operations slow and more complex.

However, there are now solutions available that can easily incorporate multiple document sizes and even X-ray imaging. Dentegra Group, Inc., one of the country’s largest dental benefits delivery systems, implemented a solution that combines document and X-ray imaging to streamline its own claims processing operations.

The solution was developed by OPEX Corporation and Mavro Imaging to allow this one-touch system to process all documentation in sequence without presorting. Both printed and film X-rays are processed without special envelopes, patch sheets or stickers.

Each scanned document is automatically classified. Documents that can’t be classified are forwarded to an image review process. Smart batching technology routes the claims automatically based on claim type. This makes it possible to scan large volumes of claims with less labor and greater accuracy.

The insurance industry is moving toward a more digital and more automated future, one in which data analysis will play a key role in better serving consumers and reducing risk and cost. Digitization of claims documents is critical for this transformation, and intelligent documenting imaging and management can ensure paper documents can be easily integrated into these new workflows. 

Our team of project managers, engineers, and analysts can assist and support you through your document management and mailroom automation evaluation and implementation process from start to finish. Contact us today via phone (+1 856.727.1100) or online to learn more.