Sample Claims Processing Process

Pick-up and Stamping

We pick-up daily from your place of business. Claims are stamped with a bar-coded micro image number before they are scanned. The numbers will then be reported to you within 24 hours. After all documents are scanned and processed the scanned numbers are compared to the stamped numbers to ensure sure no claims were missed.

Most Electronic Medical Claims Processing systems have the ability to digitally attach a Julian Date to a claim, but we do not recommend using those functions. By not manually stamping claims, you run the risk of losing claims. We Always manually stamp claims before scanning them.

Mail sorting

Many health care providers don’t like to pick up their mail. Fortunately for them, we offer mail sorting services as well. We set up a PO Box for all your claims to be sent to. We then sort and stamp all claims picked up on that day.

Claims Scanning

Each claim is scanned at 300 dpi by the industries latest VRS (Virtual Re-Scan) scanners and then visually checked by a human operator. Image processing is used to check for skew, brightness/contrast, and alignment. Any images that do not pass initial quality tests are rescanned.  Our Bell and Howell Spectrum scanners employ a technology called whistle mis-feed detection.  These scanners send sound waves through the paper to detect mis-feeds.

Optical Character Recognition (OCR)

Type written forms that are printed on Red-Line dropout forms are OCR’d (Optical Character Recognition) by two separate OCR engines to extract the needed data. The software then decides which data is more reliable by using advanced algorithms. Some fields will be keyed and compared to the original OCR’d data. All data is reviewed by a live human being and visually compared to the original image.

Manual data extraction

Black and White and/or handwritten claims are manually keyed by our data processors. A black and white form can not be OCR’ed with any accuracy. All fields follow custom business rules and are validated against customer supplied tables to ensure accuracy. Most fields will have basic logic built into the processing, for example, valid date ranges, data lengths, alpha, numeric, alpha-numeric data, and much more.

Business Rules and Tables

Advanced business rules and tables are used to set up the templates that will be used to process your claims. Tables are used to validate CPT, Diagnosis, and HCPCS codes. Advanced rules will used to determine the validity of data.  See our HCFA processing sample for detailed examples.

Ansi X12 EDI 837

After the data is extracted and validated, a HIPAA compliant ANSI 837 file needs to be created. To see a sample X12 837, please click here.  Images of the original claims in a fully searchable imaging database should also be delivered. The original images can be retrieved in seconds for claims that may require further adjudication.

After all processing is completed and all files converted to the ANSI 837 file format, an email will be sent confirming the files are available for immediate download or delivery. Every 24 hours, a days worth of claims should be ready for delivery.

This is the fastest solution and will leave you wondering why you ever processed paper claims on your own.

Whether you would like to process your own claims or send them out, an Electronic Medical Claims Processing process should always be used.