Improving Medical Forms Processing Using Automated Data Capture Solutions 

Automated data capture pulls information electronically from paper forms using OCR and other capture software. This information is then formatted and converted into electronic data files for processing in downstream systems. These automated processes have replaced much of the manual data entry and the inefficiencies associated with those legacy processes.

What Types of Forms Have Benefited From Automated Data Capture Solutions?

Standard Claim Forms

Standard claim forms, such as CMS1500, UB04, and Dental claim forms benefit greatly from automated data capture solutions. The standard formatting of these forms, well-defined business rules, and the large overall volume makes them an ideal candidate for automation.

The standard formatting allows OCR and other capture systems to be fine-tuned to each specific form type. This allows each field to be read from a known location predictably and reliably. The structure of the form can also be used to scale and resize itself to overcome distortion or resizing issues from faxing.

Each of these claim forms has well-defined business rules for submission which in turn can be used to self validate much of the information captured. This type of validation can first be applied at a field level, ensuring that the data read for each field matches the expected format for that field type. An example would be that a date field should be read as numbers. Any non-numeric values captured would obviously be an error and can be easily detected and flagged for correction. The claim data can also be validated in its entirety through the use of EDI and SNIP validation.

As these standard forms are so prolific the amount of time saved capturing a form automatically compared to manual processing is magnified across the entirety of the volume. This efficiency gain alone is monumental for both being able to process the claim data more rapidly as well as the substantial cost savings of not having to pay the labor component associated with time spent on manual processing.

Explanation of Benefits

Explanation of Benefits (EOBs) submitted with claim forms present several challenges for payers to process. The data often comes in a variety of layouts and formats which can be confusing for analysts to review and process. Automation and intelligent capture solutions overcome these obstacles present in reading the information. This data can be validated and corroborated on the fly, comparing all of the amounts and values read for each copay, coinsurance, and other adjustments and verifying that all of the adjustments and payments balance out.

What Other Aspects of Healthcare Been Positively Impacted by Automated Data Capture?

Similar data capture automation can also be applied for non-claim and other non-standard healthcare correspondence. These non-claim types of documents include Rx claims, claim adjustments, member reimbursements, appeals, operative notes, and just about everything else imaginable.

At Smart Data Solutions, we have configured full front-end correspondence handling solutions that perform the indexing, form identification, and routing of correspondence and other non-standard materials. This automated pre-processing greatly increases the overall efficiency with which these documents can be processed.

Smart Data Solutions Continues to Enhance and Improve Upon These Processes

At Smart Data, we are continually updating and improving our processes. We always look for new and innovative ways to increase our value to clients and deliver higher quality data. We are consistently updating and adding more capabilities to our automation suite.

To see what we have to offer, contact us here.