Group Health Cooperative

Headquartered in Seattle, Washington, Group Health Cooperative includes the Northwest's largest and most respected Health Maintenance Organization (HMO). A true cooperative, all enrollees are eligible to become voting members to select the Board of Trustees and approve policy at no extra cost. In 1998, Newsweek magazine rated them fifth best in the nation and commented: "Why don't all HMOs operate this way?"

Group Health already enjoys the third lowest percentage of administrative expenses among 31 Washington State health plans, yet their pursuit of efficiency and cost-containment continues. Case in point: In 1999, Group Health deployed Datacap Taskmaster for Medical Claims linked to a HSDiamond adjudication system and a FileNet document management system to completely automate the processing of their HCFA-1500 and UB-92 health claims.

The Challenge

What led Group Health to select Datacap Taskmaster for Medical Claims was a desire to trim expenses and accelerate claims data entry. The HMO receives somewhere between 5,000 and 6,000 claims per day - about a third arrive in electronic (EDI) form, the rest are on paper. Previously, Group Health was using a Kodak OCR system for data entry on about half of their paper claims and manual data entry for the rest.

"We had several reasons for considering a new approach," explained Rick Ridgeway, Manager of Claims Development for Group Health. "The Kodak system wasn't Y2K-compliant, it could recognize the HCFA 1500 form, but not the UB-92 claim, and the number of claims verified was not as good as we wanted."

The Solution

Taskmaster for Medical Claim's tight integration with FileNet was another important advantage for the HMO, which has made a reputation of providing superior customer service. FileNet's rapid claim and archival retrieval capabilities made possible a system where claim data, once captured by Taskmaster for Medical Claims, is uploaded to FileNet and stored on a server that offers direct thick client access as well as thin client web access.

The Results

Rick Ridgeway sums up the benefits to Group Health: "With the combined Datacap-FileNet solution, we're able to get claims inputted faster via Taskmaster for Medical Claims, and FileNet gives us the ability to respond much faster to provider questions. Before this system was in place, when a question came in about a claim, it might have taken a full day to retrieve the document, return the call, and resolve. Now, the adjusters can take the call, pull up the original claim on their screen and answer the question right then."

In addition, the productivity gains from Datacap Taskmaster for Medical Claims have already had an impact on Group Health's return on investment goals. "We needed seven or eight people to handle data entry of about 4,000 paper claims a day. Now, four people can process the same volume," said Ridgeway. "Datacap has increased our ability to be efficient as well as our capacity to accommodate more claims growth."