Blue Cross Blue Shield Of Arizona
An Enterprise-Wide, Flexible Solution for Processing Medical Claims"I see this as a project that could go on forever, expanding to include the entire company..." -Ed Davis, Director of Support Operations at BCBSAZ
| With more than 700,000 members, Blue Cross Blue Shield of Arizona (BCBSAZ) is one of the Grand Canyon state's largest health insurers. Like many large managed care insurance organizations at the beginning of the 21st century, BCBSAZ faces a daunting array of technical and organizational challenges to keep pace with growing business opportunities, while adhering to increased governmental regulations. Recently, BCBSAZ has implemented an enterprise-wide capture solution for processing the thousands of health claims, superbills, enrollments, and related documents that flow through the company's Phoenix-based mailroom every day. The solution integrates Datacap Taskmaster for Medical Claims with Kodak scanners, Fujitsu scanners and a FileNet document management system to create a comprehensive imaging environment for the entire organization. Since implementing Taskmaster, BCBSAZ has tripled their document volume, with a small increase in staff. |  |
The Challenge
After a decade of steady growth in the 1990s, BCBSAZ had accumulated a number of input systems to process its workload of 20,000 documents a day. An early user of scanning and OCR (Optical Character Recognition), the company was relying on a system from the early 90's to process about a third of the 12,000 claims a day they received. Another third was processed manually, with the balance outsourced to local service bureaus. Enrollments and other documents were also scanned, and documentation was stored on microfilm.
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Key Solution Facts Components
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If a customer called with a question, it took 24 hours to retrieve the microfilm and print a hard copy. Often it could take several return calls to get a claim inquiry resolved. BCBSAZ envisioned a system that would heighten productivity of claims processing, streamline their complicated document management strategy, and help reduce operating expenses, while still maintaining the positive aspects of its existing business practices. |
The SolutionGiven responsibility for the project, Karen Abraham, BCBSAZ's Vice President of Finance, applied Total Quality Management techniques and emphasized cross-department cooperation. "We included everyone with a stake in the outcome - IT, Claims, Finance, Operations, etc. - and we made sure that we were respectful of everyone's input," reports Abraham. |
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The team developed a list of goals, which included financial objectives, such as "Reduce Operating Expenses," but also benefits, like "Create A Single Point of Entry for Images," "Reduce Training Time," and "Shorten Time To Resolve Customer Inquiries," which became the template for selecting a solution. Abraham and company assumed they'd need a combination of capture solutions to feed the organization's diverse legacy systems. However, when Taskmaster for Medical Claims proved that it could capture and route all of BCBSAZ's documents through one input, the choice became easy.
The solution presented by Knowledge Lake, a Datacap Solution Provider focused on the health insurance industry, begins with three Kodak scanners. Next, Taskmaster for Medical Claims receives the images, applies dual OCR recognition and passes them through a series of validations.
Following background processing, claims are reviewed by an operator, using the Taskmaster for Medical Claims verify screen, which highlights low-confidence characters and failed validations for fast repair. Claim data is then uploaded to one of four different adjudication systems, while claim images are stored on a Hewlett Packard optical jukebox. Non-claim documents, such as correspondence and enrollments, are indexed for storage and forwarded to the proper department. The FileNet document management system provides the access and permissions for each department to use data or images as they need.