ClaimAction Benefits & Features

Process Any Claim Forms

ClaimAction supports both old and new format forms used by individual medical providers (HCFA/NUCC-1500) as well as the medical institutions (UB-92/UB-04).

No Templates Configuration

ClaimAction is pre-configured to process the medical claim forms. That means you can start processing forms right away, without wasting time on costly template configuration.

Centrally Managed Workflows

Configure your workflows and manage them centrally. docAlpha provides a visual drag-and-drop workflow configuration tools. All settings such as image pre-processing, automatic classification, recognition, database lookups, rule validation and reconciliation and export details can be configured per workflow to help meet the business requirements.

Simple and Efficient Verification

The verification station that utilizes the SimpleCapture intuitive UI allows zeroing on any questionable areas and fixing any business rule violations quickly and efficiently.

Automatic Validations

Recognized data is automatically validated through database lookups, reconciliations, math and other validation rules. The system also allows adding customer-specific rules to automate as much of validation as possible.

Processing Medical Claims

Artsyl ClaimAction package provides automated capture capabilities for medical claim old and new stile of forms - HCFA-1500 (also known as CMS-1500) and UB-92 (also UB-04). It can auto-detect form type (thus abolishing the need for manual pre-sorting), locate all fields on the page, recognize them, and apply known business rules for auto-detecting suspicious areas that require the verification operator's attention. The purpose of the solution is to drastically decrease the number of keystrokes necessary to enter information from medical claim forms. This translates into saving time and resources and ultimately into reducing the cost of doing business.

Medical claim forms have a red background designed to facilitate data capture. When scanned with standard settings with a red lamp, the red background becomes invisible to the scanner and is dropped. Only the information printed in black ink is left on the scanned image, because it is visible to the scanner. So, in an ideal world where all forms are scanned with proper color drop-out settings they are easily readable for OCR systems to allow full automation of capture.

Now let's see what happens in the real world. First, not all forms scanned in the red drop-out mode are scanned appropriately. As the typical example on the left shows, improper scanning settings often leave a lot of "semi-dropped" background, creating dense noise and garbage characters that interfere with the recognition process. These background remains have to be filtered out by the technology to reduce the number of keystrokes needed to enter the data from the forms automatically.

Second, not all customers will submit the forms scanned in drop-out mode. About 10-20% of the medical claim forms are usually received in black and white - either scanned with a B&W scanner or faxed in. In that case ALL formatting is retained, and the color drop-out design of the form does not help to capture the data at all because the background is not dropped. Therefore, an automated capture solution must be ready to process such B&W forms as well.

ClaimAction is capable of processing all of the mentioned forms. Of course, if the originals are scanned properly, recognition accuracy is higher than in the event of improper scanning. But regardless of the way the forms are scanned or faxed in, their processing can still be facilitated by the use of ClaimAction. Good scans will require fewer keystrokes by verification operators and poor scans will require more, but all possible scenarios will benefit from reducing the total time to enter the data due to automation of the capture process.

If you process medical claim forms, or plan to extend your business to do that, let our team share our experience in automating the process with you. You can contact us to see a web-based presentation or sample run of a batch of forms through ClaimAction; we can help you calculate the expected time to automate the process in your environment and the ROI for it. ClaimAction Package is available in several versions suited to a wide range of project sizes and budgets.