After decades on the "outside," alternative health practices are gaining acceptance within mainstream medicine. With more people viewing visits to the chiropractor, acupuncturist, or the herbalist as necessary to good health, a new type of health insurance organization is emerging and thriving.
Complementary Healthcare Plans (CHP), based in Portland, Oregon, recognized the potential market for covering "alternative" health services. The company already serves 1.3 million members in Oregon and Washington States, and subscriber rolls are growing fast. With success, CHP is confronting the issues of rapid growth, among them how to process and pay three times as many health claims flooding in, compared with a year ago.
By late 2000, CHP's mailroom was receiving an average of 500 claims a day, with projections of up to 1,500 within a year. A manager and staff of five were charged with entering data, resolving exceptions and adjudicating claims. Realizing they'd have to triple the department if they continued manual processing, CHP management took a close look at imaging solutions.
They settled on Datacap Taskmaster for Medical Claims, a complete scanning solution that offers dual OCR recognition, dynamic templates, 100% capture of all fields on the HCFA 1500 and UB-92, built-in validations, a modeless, single pass data entry screen, and HIPAA-compliant 837 EDI output. From a business perspective, Taskmaster for Medical Claims offered CHP a way to process more health claims with the same amount of staff.
Installed in early 2001, the Datacap software solution began churning through 500 claims a day, which are batched and fed into a pair of Kodak 2500 scanners, outfitted with Kofax Adrenaline cards. The Kodak scanners are fast enough for CHP's volumes and offer the added advantage of grayscale scanning.
By incorporating the Taskmaster Autothresholding Task, CHP is using grayscale scanning to solve one of the perpetual problems of imaging -- processing the 15% (and higher) number of claims with type too faint to be recognized by OCR. Typically, light type claims are separated for special handling, but with grayscale scanning and Taskmaster for Medical Claims, CHP is processing them right along with the normal claims.
John Amond, CHP's system administrator, appreciated the simplicity of its install. "All Datacap software came on one CD," he said. "Installation was straightforward and now we just feed claims into the scanner without having to worry about image quality."
For CHP, the installation of the imaging system with the Taskmaster for Medical Claims application is just the beginning. Currently, claim images are stored on CD for archiving, but by summer of 2001, CHP will install an OTG/Legato document management system. Amond and his colleagues will make a few simple changes to the workflow and Taskmaster for Medical Claims will easily interfaces with OTG/Legato.
"CHP has been very strategic in its approach to growth," stated Scott Blau, Datacap President. "By adding Taskmaster for Medical Claims, they've digitized their claims processing, taken a big step towards HIPAA-compliance and laid the foundation for future expansion. As a small claims processor, they have taken advantage of the same features we offer our larger customers, like Blue Cross Blue Shield of Arizona."