Community Health Plans
Our Community Health Plan clients have seen a large influx of new members and an increase in claim volume under the ACA, straining the claims adjudication process. DocuStream reduces claim and Prior Auth backlogs and speeds up adjudication by scrubbing and formatting incoming data so that it validates correctly against the health plan's own databases. This greatly reduces the amount of work required to approve or deny claims and auth requests.
DocuStream provides high-volume claims processing services to a wide array of healthcare payors. Our services include high speed scanning, intelligent forms recognition and zoning, high accuracy OCR data capture, manual correction and rule-based validation, provider & eligibility scrubbing, EDI file formatting, and Coordination of Benefits processing.
Because we combine state-of-the-art automation with diligent manual quality control, we are able to process our clients' claims from both paper and electronic sources with fast turnaround times and extremely high accuracy.
TPAs & Unions.
We work closely with TPAs and union plans to meet their unique requirements. If processing needs to be done in the US with American labor, DocuStream will do it at a fair price. And because of the efficiency of our workflow operations, that price will probably be lower than expected. Give us a call today to find out how DocuStream can meet your US claims processing needs.
Clinics & Physician Offices
Clinics, hospitals, and physician offices can now send their remaining paper claims in electronic format right from their existing billing systems via our DocuHealthLink service. This not only eliminates the remaining paper, but also provides immediate notification of claim submission and reject status, reducing phone calls and duplicate resubmissions.
Community Health Plan
One of DocuStream's longstanding clients is a Medi-Cal Community Health Plan that has seen a large influx of new members since the ACA and Medi-Cal expansion. This caused a spike in claims and Prior Auth requests, many of them still arriving via paper and fax.
DocuStream had always provided mailroom letter opening in addition to our regular scanning and data capture services, but this situation required a new approach.
For this customer, DocuStream is using DocuHealthLink to transform a portion of the paper claim flow into an electronic process – without changing any systems or processes on either the provider or the payor side. You can also read the Prior Auth processing case study here.
Coordination of Benefits
Coordination of Benefits has always been a complex adjudication problem. And when such claims must be processed on paper, the workload for the claims staff increases dramatically.
DocuStream developed a semi-automated, high-volume processing service that matches each data record from the CMS-1500 or UB04 claim with the corresponding record from the Explanation of Benefits or Medicare Remittance Notice.
The result is a very accurate matched record that is scrubbed, validated, and pre-adjudicated prior to upload into the payor's system. Now the claims staff can focus on the high-level decisions, dramatically increasing their productivity.