Touchpoint Health Plan is a managed care organization, based in Appleton, Wisconsin, that was founded in 1986 by a group of Wisconsin-area hospitals and doctors to provide health insurance to the local community. Today, with more than 145,000 members, it has recently been acquired by UnitedHealthcare and will soon become part of their nationwide network of healthcare plans and services.
Touchpoint processes more than 1500 medical claims (HCFA and UB-92) every business day. To automate the capture of paper claims, Touchpoint installed Datacap Taskmaster HCcs (Health claims capture system), which extracts and validates medical claim data from images provided by a Kodak 5500 scanner. Taskmaster HCcs routes validated data to a Tapestry adjudication system and sends indexed claim images to a Stellent document management system (formerly Optika).
Throughout the 1990s, Touchpoint manually entered claim data, and required six full-time data entry operators just to keep pace with volume. There were a significant number of errors, which further slowed productivity, and backlogs developed. In 1999, Touchpoint began looking into the new generation of systems that use Optical Character Recognition (OCR) to automate medical claim data entry in an effort to speed processing time and lower overhead. They selected Datacap Taskmaster HCcs, the first solution that integrated imaging technologies and OCR specifically to capture claim data.
Taskmaster HCcs processes claim images, forwarded from the Kodak scanner, by routing them through a series of steps to extract and validate data. First, images are prepared for recognition with image processing – “image noise,” such as lines and speckles, is removed and skewed images are realigned. Then, two OCR recognition engines “read” each image and vote on the results. Taskmaster HCcs uses these results to determine whether there are characters that should be verified by human eye.
Next, the extracted data is automatically subjected to a battery of validations. Zip codes are checked against city names, member numbers are confirmed against a master list, diagnoses are matched with CPT codes; even the math is checked by a calculator.
The verification process that follows is the one step that involves human interaction. At Touchpoint, three operators view the HCcs user interface, which displays claim image and recognized data side by side. Any issues requiring their attention are highlighted in color. “Low Confidence” characters are identified in yellow and failed validations are highlighted in red. Operators move quickly through each claim image, fixing individual characters if they are incorrect, and fixing data that has failed a validation.
Finally, all verified claims are exported – the data going to Touchpoint’s Tapestry adjudication system for payment, and images, with indexes, are committed to the Stellent document management system.
Touchpoint has been a loyal Datacap Taskmaster HCcs user for five years of continued growth and change. Along the way, Touchpoint switched to the HIPAA-compliant export format, expanded volume to process the company’s HMO and PPO claims, added new claim types (UB-92s and Mental health HCFAs), and switched adjudication systems to Tapestry. Taskmaster HCcs accommodated each new challenge smoothly, helping the organization manage change.
Dawn Beyer, OCR Specialist, has supervised the Datacap system since 2001, when she joined the company. "With Taskmaster HCcs, we have just three operators to process what we needed six people for previously. And our volumes have continued to rise as our membership increases," she reports. "The Taskmaster HCcs system has proven to be very flexible, allowing us to run 98% of all incoming paper claims through OCR, which reduces our manual labor significantly."
About DatacapSince 1988, Datacap Inc. has provided leading document capture and forms processing software solutions to organizations worldwide. Datacap Taskmaster software efficiently transforms paper into digital information, reducing data entry costs and improving information accuracy. A client/server, rules-based capture workflow platform, Taskmaster provides highly flexible solutions for both image indexing and data entry automation. Taskmaster also enables scanning, indexing and administration from a browser and integrates with all leading document management solutions.