Claims Processing

Business Process Outsourcing | BPO | shutterstock 99967472 300x200The insurance industry is one of the most paper-intensive industries out there. Applications, proposals, underwriting, administration and change forms, reimbursement forms, claim forms, annuity forms, life insurance forms, health insurance forms, auto insurance forms, disability forms, supplemental medical, the administration and settlement of claims  that’s a lot of trees. Even when a claim is settled, it often results in more paper. Every insurance company would like to reduce its dependency on paper, but how does an organization get there? An experienced BPO provider can manage your paper problems with efficient document processing solutions.

Handling large stacks of paper documentation is labor-intensive and risk-laden. Everyone in the industry can save money and make better use of their time by reducing paper. This week, Property Casualty 360 released some steps to a paperless office. Here’s our abbreviated version of this useful list:

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In healthcare, automating every step of the pre-adjudication cycle – meaning anything that happens before the payment of a claim – allows claims to be processed more efficiently and more accurately. As claims processing improves, auto-adjudication rates rise and the total cost per claim falls.

Healthcare payers and benefit administrators are provided with pre-adjudication technologies that replace error-prone human processes and provides applications for PPO network management, document management, workflow and overpayment protection. These solutions improve adjudication rates, increase payment accuracy and enhance customer service. Simply put, business process outsourcing can provide better, faster and more cost-effective processing than any manual, in-house paper-based method.

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The review, investigation and processing of claims can be time-consuming and prone to human error. By initiating an advanced healthcare claims processing system, you can alleviate many of these issues and ensure the accuracy of all claims processed.

Paper and electronic data interchange (EDI) claims can be imaged and converted to electronic format and transmitted back to integrate with the appropriate claim system. With a special focus on the front-end operations for claims processing, 100 percent electronic claims submission can be enabled to reduce administrative costs and improve auto-adjudication rates.

The most trusted BPO companies have made significant investments in enterprise software and infrastructure development, specifically addressing data security requirements. Annual external audits can ensure compliance; and multisite processing models can allow for superior business continuity and disaster recovery capabilities.

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For years, Electronic Data Interchange (EDI) claims submission has reduced payer rejections and administrative costs while increasing the speed of the payment. So why do EDI transactions still have adjudication issues? The reason is that the best data the provider has is simply not good enough.

Payers and providers have natural differences in update cycles, systems and business processes that contribute to adjudication errors. Payers contract with providers at longer periods than members – and members often update their information only annually.

More often than not, data is never given to the provider until an encounter, so demographic data becomes stale very quickly. This means providers have little opportunity to get patient data corrected. Plus, they have limited resources and capabilities to keep their own demographic data synchronized with every payer.

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Business Process Outsourcing | BPO | 162237897 300x225Healthcare claims processing can involve expensive and serious consequences if the data is not processed correctly. To address these issues, healthcare payers and benefit administrators are turning to digital pre-adjudication technologies to replace error-prone human processes and increase claim payment accuracy. This involves electronically organizing the data before the payment of a claim is made.

Using technology instead of manual processes allows the solution to be customized to adapt to specific business requirements and improve performance without additional capital investment. Advanced BPO providers can automate the claims process, including claim data cleaning to increase claims quality and reduce overall costs.

With the right technology, healthcare claims can be improved so that they match system files; thus, lowering reject rates and improving adjudication rates all while ensuring HIPAA security and consistency.

Automation Technology Can Advance the Claims Process

The latest automation technology can increase data accuracy, lower costs and bring faster cycle times to the healthcare claims process. The technology can automate and integrate all aspects of pre-adjudication claims processing, including cleaning and enhancing claim data.

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Business Process Outsourcing | BPO | security The security of medical records and healthcare claims is a sensitive issue recognized by industry leaders in healthcare. HIPAA compliance standards ensure that healthcare claims and related information remain secure and protected.

The most effective claims processing is accomplished with automation technology that offers advanced pre-adjudication services. These services take care of everything that happens before the payment of a claim. However, some claims still require exception processing – meaning human intervention to investigate and correct individual fields that don’t meet standards.

The option of hybrid onshore/offshore claims processing has become a model worth considering. Redaction is made possible using form definition technology to slice through each claim image, and physically separates the patient/insured section, which contains the personally identifiable information (PII), from the rest of the claim. Redaction technology eliminates any possibility of a person or software illicitly obtaining the image or OCR results for PII fields.

With this model, the fragment containing PII can be routed to a trusted onshore location for exception processing while the non-PII fragment containing provider and service lines can be routed to an offshore location for exception processing at a lower cost. This balance creates a cost-effective process that meets all state-mandated requirements.

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Business Process Outsourcing | BPO | bpo challengesLeaders in healthcare have long recognized the challenges when it comes to claims processing. Healthcare payers and benefit administrators have begun to focus on the front-end process to help reduce operational costs, increase adjudication and first-pass rates, and improve overall customer service.

Many BPO challenges in healthcare claims processing involve:

  • Claim data accuracy
  • Scrutiny of payments
  • Patient privacy demands
  • Regulatory mandates
  • Processing costs.

Inaccurate, incomplete or erroneous data – dirty data – often results from a lack of updating of claim filing with payer system records. This data must constantly be synced to allow for increased member and provider matching.

Furthermore, as a result of healthcare reform, federal agencies are initiating more robust audits, leveraging new technologies and focusing on improved healthcare processing integrity. These efforts reduce payment errors and prevent taxpayer dollars from being wasted in payments to the wrong people and in the wrong amounts.

Electronic claims are becoming an industry standard, and patient privacy is one of the most important elements of healthcare information technology. With HIPAA requiring facilities to protect their electronic medical records with the proper IT security controls, guaranteed compliance with stringent security and information safeguards is essential.

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BancTec’s Chuck Corbin discusses the complex tasks healthcare providers and payers face when it comes to claims processing, including reconciliation of claims, incoming EOBs and payments, compliance mandates and more. He explains why the opportunity lies in the management of financial transactions in the healthcare sector in the United States.


Happy Holidays from BancTec

by BancTec on December 21, 2012

Business Process Outsourcing | BPO | Coley Clark 193x300 Coley Clark, BancTec’s CEO

Today’s post is from Coley Clark, BancTec’s chairman of the board and chief executive officer.

As we near the end of an eventful year, I’d like to wish the happiest of holidays to BancTec’s customers, partners and employees. This year marked our 40th anniversary, a real milestone for BancTec and a reminder of the rich heritage we enjoy.

BancTec continues to establish itself as a leading BPO company across many industry sectors.  In particular, we have made significant advancements in the healthcare industry, accelerated by the acquisition of GTESS and its healthcare claims processing services. In Europe, we continue to leverage our financial services experience. BancTec has captured 100 percent of the outsourced GIRO payments in Sweden.

Looking to the future, we know that the new year will bring new challenges and opportunities. I am confident that together we will embrace the challenges and take full advantage of the opportunities.

Until then I wish you safe and happy holidays with family and friends, and a joyous, prosperous new year.


Consider how many documents your business sends, receives and processes each day, from claims and invoices to vouchers and general correspondence. These processes require standardized methods to ensure efficiency. Today, companies are shifting to electronic document processing to automate and optimize their business processes.

In this video, BancTec highlights its imaging and image archive services, inbound mail processing and claims processing solutions. Using its Intelligent BPO (iBPO) methodology to provide a smarter way to outsource document management, BancTec leads companies to:
·      Lower costs
·      Reduced risk
·      Better service
·      Improved business intelligence.