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 processing.

Claims are stamped with a bar-coded micro image number before tMedical Claims Stampinghey 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 them.


Mail sorting

We offer mail sorting services as well.  A PO Box can be employed for all your claims to be sent to. 


Claims Scanning

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.

 

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We offer a complete workflow solution that includes scanning and hosting in the cloud.

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(516) 255-9500