Claims Processing

We process nearly 2 million healthcare claims per month in our secure facility in San Leandro, CA. Our fully-integrated workflow includes mailroom & scanning, forms processing & OCR, manual QA and repair, automated validation and external lookups, and custom export data formatting.

DocuStream delivers more than just accurate data. We scrub and verify each field to assure that the data matches what your system expects, either from paper or EDI sources.

This may include provider and eligibility table lookups, internal completeness and consistency checks, custom field padding, and custom dictionary translations.

Such "pre-adjudication" scrubbing of claim data offloads the busy work from your adjudicators, who can now focus on high-level decisions. Our clients see 30% to 40% productivity gains as a result.

Real-Time Eligibility

Our Real Time verification provides immediate responses to inquiries from Providers for Member Eligibility or Claim Status. Providers get the information they need with one click, reducing the phone calls to your staff.

During implementation, our team thoroughly maps your benefit matrix into our Real Time verification engine. Responses are returned in the federally mandated X12 format for compatibility with most provider systems.
The ability to respond immediately to Provider requests not only saves time and money for your organization, but also ensures HIPAA and ACA compliance under the CAQH CORE rules.

EDI Data Formatting

We have worked extensively with custom and legacy data formats, helping our clients transition to the latest HIPAA-mandated EDI file formats.

For example, we can help you implement the 837 5010 claim, 277 status response, and 835 remittance advice formats. These standards are required, and CMS is imposing fines on non-compliant payors. Updating to current EDI standards will also dramatically cut costs and improve your productivity.

Prior Authorization Requests

DocuStream can process your Prior Auth Requests in a fraction of the time and cost, eliminating backlogs and freeing your staff to focus on high-level decisions.


We take in the faxed requests sent by Providers and extract the relevant data. We then scrub and verify the data for member eligibility, provider network, and other key fields.


Providers get a quick return fax, acknowledging receipt and informing them of any data fields that fail our validations. This greatly improves Provider satisfaction and reduces phone calls, duplicates, resubmissions, and inappropriate use of the Urgent check-box. Read our Case Study here.

Our standard turnaround is 12 to 24 hours for Urgent and one business day for Routine. We can also deliver a recommended adjudication of the PA Request based on our analysis of the data and the doctor's notes.

OCR Data Capture

DocuStream has been at the forefront of Optical Character Recognition for document data capture since the mid-1990s. We work closely with leading OCR vendors such as top-rated Prime Recognition.


We combine Prime's multi-engine voting OCR with automated image enhancement, as well as dynamic zoning that locates specific data fields even when the form layout has changed.

But OCR is only one step in the process. Operators and automated processes verify and correct the data before formatting to your system's specifications. The resulting data file is as accurate and complete as possible.

Mailroom Processing/Scanning

If you want to get rid of paper entirely, we offer full-service mailroom processing that includes envelope opening, paper unfolding and staple removal, sorting, scanning, date/time imprinting, secure storage, and secure shredding.

We convert the incoming paper to indexed images that you can instantly access either in your own document management system or using our ScanNStore imaging storage and retrieval software.

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