Dentegra Group Improves Claims Processing Efficiency

Dentegra Group Improves Claims Processing Efficiency
An Intelligent Scanning Solution from OPEX & Mavro Imaging has eliminated manual sorting and filing and improved claims adjudication.

Insurance claims processing is a complex endeavor, and for companies that manually manage the incoming documents, it is very time-consuming. Dental claims include a number of different forms, supporting documentation and patient X-rays, all of which must be properly classified, sorted, scanned and filed.

Dentegra Group, Inc., one of the country’s largest dental benefits delivery systems, serves enrollees in both commercial and government-sponsored programs. For years prior, the company utilized OPEX Rapid Extraction Desks® to open envelopes. Once the envelopes were opened, the contents of the envelopes were manually sorted before the tens of thousands of claims were processed on separate document scanners.

Reliable, But Not Automated.

Dentegra’s commercial claims operation processed as many as 50,000 claims each day, so manually sorting that paperwork and the included X-rays had been an arduous and time-consuming process. Sorting involved multiple steps, including sequencing, verifiying of information and adding barcode labels.

Scanning the documents required taping anything smaller than an 81/2- by 11-inch document onto a carrier sheet and inserting separator sheets to define transaction breaks in the scanning workflow. High-resolution X-ray prints and film X-rays that arrived were handled via a separate filing process.

While the opening, sorting and scanning operation was reliable, Dentegra knew that automation could help reduce labor and accelerate document processing. The organization needed additional intelligence in its systems to accomplish that automation.

Streamlining The Scanning Process

The answer came by way of a partnership between OPEX Corporation and Mavro Imaging, the provider of MavBridge intelligent imaging and document management solutions.

“We have done business with OPEX for many years,” says Francoise Thimon, manager of consolidated mail services for Dentegra. “When they approached us with the Mavro solution, I saw the potential benefits right away.”

The Mavro and OPEX solution enables one-touch scanning utilizing nine OPEX AS7200i integrated envelope extraction desks/scanners and MavBridge™ Software for claims processing. Using a single operator, documents are pulled from the opened envelope with no manual sorting and are scanned in any sequence, regardless of size. The electronic images are handed off to MavBridge where they are classified, electronically sorted based on Dentegra’s business rules, and then sent on to the next step in the claims adjudication process.

In addition to the paper handling efficiencies from OPEX, the virtual batching functionality in the Mavro solution is key to the success of this process. Every document is classified into a category based on its content, and then MavBridge automatically sorts each image into the correct sub-batch. Once those sub-batches are created, the Mavro system sends the documents to the correct downstream process as if they had been physically sorted prior to scanning.

“The people at Mavro and OPEX are incredibly knowledgeable,” Thimon says. “I don’t have a high-tech background, so I asked a lot of questions. They made me feel like they cared about my concerns and always answered to my satisfaction.”

According to Thimon, Dentegra immediately experienced benefits once the new system was up and running. Those included:

  • Labor/Time Savings: Staff no longer spends hours sorting paperwork. Most of the manual steps have been eliminated.
  • Accuracy: With fewer physical touches, there is less room for human error in the sorting and scanning process. “We operate at 99.5 percent accuracy, and a lot of that is due to the OPEX and Mavro solution,” Thimon says. “Everything that is scanned is presented for review to an employee in case a document is misclassified, but it is not very often that we have to reclassify a document. The machines and the software are doing their jobs exactly as they were designed.”
  • Employee Satisfaction: Eliminating manual sorting has improved employee satisfaction because staff can spend more time on value-added tasks rather than sortation. Reducing the paper handling has also provided ergonomic benefits, and employees are more productive. “The machines are highly ergonomic,” Thimon says. “Our employees’ health is important above all, and the solution is designed for their comfort and safety.”
  • Productivity Tracking: Managers have real-time visibility into staff productivity using the dashboard in the Mavro solution. “With the dashboard, we have at our fingertips an incredible amount of data about our operation,” Thimon says. “We don’t have to guess what our employees are doing. We can see when they are scanning or batching, and the information is incredibly detailed.”

About Mavro Imaging

Mavro Imaging provides end-to-end remittance processing and document imaging solutions, with a focus on lockbox and service bureau solutions. Mavro’s services range from complete system design and implementation to consultation for improved operational efficiency.

Mavro Imaging’s approach is based on gaining a full understanding of a customer’s needs. In turn, the Mavro solution team presents a wide range of possible processing and configuration options. The result is a combined Mavro / Customer team collaborating to optimize and implement the best possible solution. A collaborative approach, exceptional service, and innovative technology. For more information, visit www.MavroImaging.com

About OPEX Corporation

OPEX Corporation at its core is all about optimizing business processes. As a recognized global technology leader in document imaging and high-speed mailroom automation since 1973, OPEX systems have provided performance enhancing workflow solutions and cost-effective results to thousands of organizations worldwide. Today, OPEX systems are installed in financial services, healthcare, government, non-profit, utility, service bureau, insurance, telecommunications and university/educational marketplaces around the world. For more information, visit www.opex.com.
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