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Healthier OCR at BCBS

With its volume of paper claims ever-increasing, BlueCross BlueShield of Tennessee embarked on an enterprisewide system for converting paper claims to electronic forms.

The company decided to deploy an optical character recognition (OCR) solution that has enabled 150 adjudicators to handle a greater volume of paper claims than 550 processors did three years ago, and the company has also trimmed data entry personnel from 157 to 140.

"In the short term, HIPAA is having a counterintuitive effect—we expect to experience a 21% increase in paper claims as a result of the legislation," says Deanna Quinn, manager of creative business solutions with BCBS of Tennessee. "Eventually, paper claims will go down as new systems come online; however, right now physicians are still filing primarily paper claims."

In the mid-1990s, BCBS of Tennessee used a baseline OCR system that consisted of several standalone scanners, which were difficult to maintain and control. The CIO focused the organization on finding an enterprisewide OCR system that could provide a consistent solution for all employees and one that would integrate with existing FileNet software.

The organization chose Transform and HealthClaim Expert software from dakotaimaging, a WebMD company. The new system has enabled BCBS of Tennessee to increase the volume and accuracy of processed healthcare claims. It now processes an average of 53,000 HCFA, UB, Medicare and Medicaid claim forms per day and maintains the capability to process up to 80,000 claim forms if necessary. Leveraging the solution's healthcare-specific rules engine, auto-adjudication rates have jumped from 30% to 75% of claims, according to a recent press release.

"From a numbers perspective, we gained a clear ROI from the implementation of this technology," says Quinn. "No one envisioned that a new system could handle more than 250 HCFA forms per hour; however, we now process 400 claims per operator per hour. The advantages have also been qualitative. I know where each and every claim is in the process at any given time—resulting in our ability to enhance the accuracy and timing of our customer inquiry responses."

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