Diversified is fully HIPAA-compliant.
A major healthcare insurance
company, ranked among the top three in the U.S., had 14 regional mail
processing centers handling incoming claims, correspondence and checks.
Faced with enormous overhead, staffing requirements and varying processing
standards, the company elected to consolidate this function with Diversified
Information Technologies.
All mail was re-routed to
Diversified, where it is retrieved from the USPS regional distribution
center every two hours, Monday–Saturday. Barcode technology was incorporated
into the process to track each mail container and verify turnaround times.
Once all
correspondence is extracted, documents are sorted into categories
and prepped for scanning, including removing staples, mending tears
and inserting file separation sheets. Then the documents are imaged
via high-speed production scanners. An image audit of each batch
ensures that all electronic files are present and readable.
After imaging, data
from the files is captured by using a double-blind entry system.
Finally, data is validated against client-specific tables, allowing
up to 70 percent of the claims to be auto-adjudicated.
The final step in
this process is exporting the electronic data and images into the
client’s workflow system.
By outsourcing their
mailroom and claims processing systems to Diversified, the customer
reports cost savings in the following areas:
- Higher
auto-adjudication rates result in lower
processing costs
- Improved
turnaround times lessen state-imposed penalties
for slow claims payment
- Consolidation
of facilities lowers overhead and operations
costs
Diversified
currently processes more than 750,000 claims per week for this one
client, or more than 70 million claims yearly. The client’s
specified turnaround time of 24 hours is consistently exceeded, and
data-extraction accuracy rates of 99 percent are well above industry
standards, and significantly higher than the nearest competitor.
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