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Medical Claims Processing at Central Coast Alliance for Health

The Central Coast Alliance for Health Increases Productivity with Datacap Taskmaster While Doubling in Size

The Central Coast Alliance for Health, known by its members as “the Alliance” is a locally operated public health plan serving Santa Cruz and Monterey Counties serving more than 78,000 residents. The Alliance has realized significant cost savings and efficiency through data entry automation with Datacap Taskmaster for Medical Claims. The Alliance is the Medi-Cal health plan for Santa Cruz and Monterey Counties and supports Healthy Family, Healthy Kids and In Home Supportive Services. The Alliance is committed to ensuring cost-effective access to publicly financed health care.

The Challenge

Prior to implementing Taskmaster for Medical Claims as their capture solution, 12 members of the Alliance’s 35-person staff manually entered and processed HCFA 1500 and UB-92 medical claims from healthcare providers, institutions and 30,000 Alliance members in Santa Cruz County. The process could take weeks, requiring low-income and disabled applicants to wait long periods of time for reimbursement.

Key Solution Facts

Components

              ROI

  • 400% increase in productivity

In 1999, the Alliance made plans to acquire Monterey County and 48,000 new members. With more than twice the amount of claims to process, the Alliance quadrupled its workforce, but reduced the data entry staff by half with the help of Datacap Taskmaster and Fujitsu scanners.

The Solution

The Alliance currently receives 5,000 claims per week from healthcare providers, institutions and 78,000 Alliance members in Santa Cruz and Monterey Counties. Following adjudication in an Oracle-based system, claims are processed through Datacap Taskmaster using two Fujitsu scanners. Easy-to-set-up rules ensure that fields requiring alpha or numeric characters comply Documents are then stored as a disc image in an IKON system.

The Result

Since adding Taskmaster, the Alliance has reduced its data entry by half, while the volume has more the doubled – resulting in a four-fold increase in processing productivity. The Alliance now employs only five people to manually enter hand-print forms and to verify problem documents. The claims department now can focus all of their time processing claims, speeding turn-around time despite the drastically increased workload. Now the 78,000 Alliance members in Santa Cruz and Monterey County receive faster claim resolution that can help them get the medical care they deserve and the claims department isn’t straining under the weight of its new acquisition. Taskmaster for Medical Claims speeds processing time, increases accuracy and guarantees compliance by allowing administration controls only to those who need them.

“I am confident that everything is compliant because Taskmaster ensures that everything goes exactly where it needs to go,” said business systems analyst Christi Bochat. “I never worry about it.”

For more information, contact Datacap.