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How FVTech Successfully Processes Eight Million Medical Claims a Month Using Artsyl’s ClaimAction

Client

FutureVision Technologies
Industry

Healthcare
Product

Artsyl ClaimAction



Results

Ability to process:

• UB04 andNUCC forms; processing eight million medical claim pages per month;

• Identification rate for UB04s grew from zero to 85-90 percent


FVTech is One of the First to Successfully Capture UBO4 Forms

FVTech, based in Salt Lake City, is a business process outsourcing (BPO) provider, specializing in solutions for document imaging, digital conversion, and workflow management capabilities to its clients in the healthcare, insurance, manufacturing, mortgage, retail/distribution, and transportation industries.

One of FVTech’s primary focuses is in medical claims processing. When the company revamped its technology for this division, it called on FVTech’s Director of Engineering, Jose Dias to lead the charge.

As an 11-year technical veteran in the medical claims imaging and capture space, Dias knew exactly what he wanted in the new data capture solution.


Support for UBO4 with Artsyl Solution

“We were moving from a legacy system to our own proprietary platform,” said Dias. “Our previous system was limited in terms of new capabilities; UB04 forms were not supported and NUCC had marginal support. We looked to bring these and other capabilities to our new platform. We considered the amount of effort to build these templates from scratch but concluded it was better to license and leverage an existing technology,” he said.

The company had already been using ABBYY FineReader Engine SDK with FlexiCapture module for about two years in their proprietary platform. When FVTech needed a solution to automate identification of forms and data extraction for medical bills, they turned to Artsyl and its ClaimAction medical claims processing solution.

“I knew the identification and extraction problem was not a simple, trivial problem to solve,” said Dias. “Given our past experiences with Artsyl’s services and support and knowing what their engineering team was capable of, we were confident that Artsyl had the right solution.”


FVTech Conducts Rigorous Testing

Before settling on the Artsyl solution however, Dias looked into several other existing technologies in the industry, but found they were restricted in one way or another. “As a BPO organization, we need to be very flexible,” said Dias. “We need to provide solutions to our clients without any push back, and we need the same flexibility from our vendors,” he said.

Dias and his group conducted rigorous regression testing with ClaimAction using existing test sets with known problems so that they could test the product against a baseline. “We evaluated the product and evaluated it against existing systems and found that the performance results were comparable to or exceeded the other solutions that were out there,” he said.

Dias worked directly with Artur Vassylyev, Artsyl Founder and Director of Engineering to modify the Artsyl solution to make sure it worked well within his system to ensure the automatic identification and data extraction of his company’s medical claims business. “ABBYY tends to be slower but more accurate,” he said. “For clients that pay for better accuracy, it’s a better solution.”

“It was easy to work with Jose, as he takes this project as very, very important so he was very good to work with,” said Artur Vassylyev, Artsyl Founder and Director of Engineering, who worked with FVTech. “Jose wanted deeper control of the overall system, so we worked with him to customize the solution to his specifications,” said Vassylyev.


Full Production in Just Two Months

Using ABBYY FineReader Engine with FlexiCapture module as their runtime, and Artsyl ClaimAction as the definition, FVTech’s first client was in production within a few months. They’ve successfully been using their solution to process approximately two million medical claims, containing eight million pages a month. FVTech’s identification rate for UB04s has grown from zero percent to 85 or 90 percent, according to Dias.

“Artsyl’s been very supportive and responsive to our needs,” said Dias. “It’s been a pleasure to work with them. They were accommodating in working with us to resolve issues with the solution and were specific to our requirements; they’ve been very responsive and very adaptive in making it work for us.”

For more information, visit www.artsyltech.com.

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Medical Development International (MDI) is not unlike other healthcare management service organizations in terms of the services they provide. Where MDI may differ, however, is how they deliver these services and who they deliver them to: correctional systems in the United States.

Founded in 1992, the Ponte Vedra Beach, Fl.- based healthcare management services and technology company provides a full range of healthcare services to its correctional customers. According to Bobby Snyder, assistant vice president of MDI’s claims department, catering to the prison system is no different than providing such services to the general public. “We see the same ailments as the general public; we even deliver babies,” Snyder said.


Comprehensive Healthcare Management Services

A specialist in correctional healthcare, MDI contracts with physicians and hospitals to create a Custom Provider Network (CPN™) to provide inmates with necessary healthcare services that cannot be delivered inside a jail or prison.

“MDI saw the core problem the correctional system was having; they were not able to contract with the providers at a competitive price,” Snyder said. “We were able to bring them better pricing for the providers, as well as take the burden off of them for scheduling and claims processing.” MDI puts the whole process into one package so that correctional customers can focus on managing their prison systems rather than managing their healthcare services.

MDI’s comprehensive healthcare management services include Custom Provider Network (CPN™) development, healthcare appointment scheduling and confirmation, medical claims processing and adjudication, duplicate claim identification, prompt and accurate provider payment, and healthcare claims auditing.


Artsyl’s ClaimAction™ Provides a 40 Percent Increase in Claims Processing Capabilities

In the past, MDI used a double-blind keying procedure for claims processing, with two people hand-keying claims. A third operator would reconcile any discrepancies. “We got to a point where having to key in a claim twice was very time-consuming and it was starting to demand more resources,” Snyder said. “As a company, we’d rather put our money toward IT and technology rather than resources which don’t really solve the core problem.”

MDI decided to take a different tact when developing ReClaim Suite™. This complete system is used to schedule and confirm healthcare appointments, make pre-and post-op messages available to both the doctor and the prison, process claims via Medicare methodologies, and push the claims through a submission process where MDI can generate EOBs and checks for providers, as well as billing documents that go back to the prison systems. ReClaim Suite™ is unique in its ability to provide a full suite of services. “From the standpoint of a complete system, we are one of the few that does everything from scheduling appointments to paying providers in one suite of software,” Snyder said. “Most of the time it’s a very diverse group of different companies that handle different parts of the process.”

By integrating Artsyl’s ClaimAction™, a highly accurate and fast claims processing solution for extracting data from HCFA, UB92 and UB04 paper medical claims, into ReClaim Suite™, MDI was able to reduce the keying time of claims, as well as the human resources needed to do so. MDI still uses a double-blind keying procedure, but its now much faster and more efficient because it uses one human resource to key on one side, and a machine to key the other side. Using this process, they were able to increase their volume by 40 percent without adding staff. “Our turnaround times are very quick,” Mr. Snyder said.


Finding Faulty Claims

Claim overpayment is a big problem in the medical industry. On average, 10 to 12 percent of submitted claims are duplicates. In Mr. Snyder’s viewpoint, “If your technology isn’t keeping pace, you are probably needlessly paying for claims that have already been paid once before.” This problem led MDI to develop more accurate claims processing solutions.

Through its proprietary ReClaim Suite™ technology platform, MDI rigorously triple-checks all claims processed. MDI’s advanced technology flags faulty claims in its adjudication process; these faulty claims are then investigated by MDI’s coding and claims processing professionals. “Most of the time when you are talking to a third-party administrator, they literally will capture about 3 to 4 percent of duplicate claims; we capture 12 to 15 percent of duplicate claims by volume because our technology is light years ahead of theirs,” Snyder said.

Other technologies, whose purpose is to capture a high volume without equal regard to accuracy, “will only catch duplicates if they are exactly the same, where every line item is the same,” according to Mr. Snyder. MDI, on the other hand, uses a fuzzy logic system that finds more minute discrepancies in the 120,000 claims it processes annually. “If the patient name is very similar and everything else is the same, more than likely, it’s a duplicate claim, so instead of doing a simple comparison, we do a fuzzy match and do some extra effort toward adjudication,” Mr. Snyder said. This extra effort allows MDI to identify two to three times more duplicate claims than the industry average, which results in bottom line customer savings.

Mr. Snyder says that implementing Artsyl’s ClaimAction™ claims processing technology helped save MDI a considerable amount of time in processing its claims. “It reduced our keying needs by 50 percent for that second keying,” he said. “It saved us a body or two per week, and we have more accuracy without an additional resource drain. Its been working great so far.”

For more information, visit www.artsyltech.com.

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