PDI Health Claim Processing Process
Pick-up and Stamping
Pick-ups can me made by us on a daily basis from your place of business, or mail
services can be used. Additionally, claims images can be uploaded to our FTP site for
Claims are stamped with a bar-coded micro image number before they are scanned. Receipt numbers are reported
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
We offer mail sorting services as well. A PO Box can be employed for all your
claims to be sent to.
Each claim is scanned at 300 dpi on the industries latest VRS (Virtual
Re-Scan) scanners and then visually checked by an 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 an operator 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’d 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.
HCFA 837 and UB92 837
After the data is extracted and validated, a HIPAA compliant ANSI HCFA 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 are 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 will be ready for delivery.
This is the fastest solution and will leave you wondering why you ever processed
paper claims on your own.