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admin | Category: Electile Dysfunction 2016 | 11.06.2015
To enhance efficiency of the claim processing process and aid in growth plans through increased throughput and scalability.
Binary Spectrum developed a robust platform that automates electronic claims, remittances, member enrollment, eligibility and disenrollment processes for a large HMO.
Loads the claims into HMO's database (No claim will be loaded into it, until all errors are fixed). The client has scaled up the claims processing capability, and is able to do so in a timely manner while being able to deal with a variety of vendors.
Well if you are interested in outsourcing software development or would like to find out more about our services and offerings, please get in touch with us. The Client is an Australian professional data entry and processing company that helps their customers convert paper documents to ASCII documents in various formats, and make use of the data information in enterprise applications and process automation to resolve various business problems. The Client contracted the health insurance claim forms processing projects from the Health Insurance Committee (HIC). After setting up some simple software, The client mainly depended on manual input to achieve the HIC data processing.
ExperVision® owns a global leading OCR technology and has developed FPS for many clients and cooperated with some data service companies to directly contract the data service business. After they fill out personal data on paper form, patients frequentlycomplain that the paper-based medical records (MR) are often misplaced and they had to stop at too many lines during the visit. Physicians and nurses spent a great amount of time writing patient charts, and a diagnosis was often missed in a paper record.
With transfer to a new hospital or a clinic, copyies of the patients paper chart neeeds to be sent and received along with the patient.
After a couple of weeks, the loboratory reports will be archived and doctors did not have access to all information. ExperVision’s Medical Info-System streamlines patient information management and enables physician to improve patient care, enhance productivity, eliminate paperwork and help the business gain rapid ROI. Document Conversion: Covert paper records to digital formats, extract text information and import electronic records from various medical practices. Physician Order Entry: Medications, labs, prescriptions, care plan, educational materials, etc.
EMR Transfer: Integrated with or connected to medical insurance companies to transfer EMR for the claims to be processed conveniently and efficiently. BPO Service: In addition to all the automatic functions provided by the software system, ExperVision also runs a BPOCenter located in China, which provides 7 days a week and 24 hours per day manual processing service through Internet to guarantee fast processing of MRs, system reliability and data security against any spiteful attack. ExperVision Healthcare BPO performs data entry for all HCFA 1500, UB92 (HCFA 1450), ADA Dental, Rx and prescription claims using a dual validation method to ensure 99%+ accuracy.
ExperVision performs re-pricing for clients in a variety of methods, including going directly to third party re-pricing systems, or through ANSI 837 transactions. ExperVision claims examiners can log into client claims processing systems remotely using VPN, terminal services, or a variety of other remote protocols to perform claims adjudication directly on their system.
ExperVision can receive claims sent in HIPAA-compliant ANSI 837 format, and then we can convert and upload theclaims to clients in the EE importable format. We do Electronic and Paper Claim submission, depending on the doctor’s agreement with the Insurance Company.
It is a common and daily operational task to accept and process checks as a form of payment in any company, especially in retail, utility, online and offline merchant industries, etc., which we call merchants collectively.


ExperVision® has been helping various merchants meet their challenges in check processing through our innovative solution.
ExperVision® ‘s check processing system helps a company complete the process from check image capture, recognition, storing, proofing, passing to various payment gateways for transaction, to archiving for analysis and other purposes. A company receives large amount of invoices from various third parties including vendors, service providers, contract engineering providers, etc. ExperVision® ‘s invoice and receipt processing system completes the process from invoice scanning, recognition, storing, passing to various departments for verification and approval, to archiving for analysis and other purposes.
Although electronic resumes have been more and more popular since the late 90s, massive paper materials, e.g.
ExperVision® ‘s paper based workflow management system provides whole workflow management by including the traditional paper work-order and worksheet in the control loop, while allowing the staff to work exactly the way they were working before. Vee Insure is one of the first HIPAA-compliant healthcare insurance claims processing providers in the U.S.
Being a progressive company we were looking at outsourcing most of our back office processing and wanted a company that will transcend skills and assimilate to complex process. At Infosys, our focus on Healthcare is aimed at radical progress in affordability, wellness, and patient-centricity.
The necessity for dual processing with ICD-10 is not just a result of interoperability between entities on disparate code-sets. These claim forms, which are used by all Australian hospitals, clinics, medicine labs, pharmacies and other treatment and convalescence departments to declare to the HIC all services to the patients. However, the HIC data service workload was large, required high precision and had a short time frame.
The Client found ExperVision® through research and consigned it to develop the FPS for HIC claim forms.
Further adding to the troubles, nurses and medical assistants began creating their own “ghost charts” so that they could have a record filed in a place they could not easily access.
The system provides browser-based, easy-to-use, extremely intuitive access to medical practice data, including patient appointments information, demographic information, laboratory reports, transcribed documents, radiology reports and health summary. We reduce claims processing costs and streamline benefits administration operations to maximize productivity and profitability for healthcare TPAs, Independent Physician Associations (IPAs), hospitals, managed care networks and self-insured employers. We receive these documents from different facilities as an electronic fax; then, we index and store them for future reference.
The agents receive the requests from the physicians and their offices for the medical documents. We work as the client’s offshore team in doing the correct billing and providing the right AR follow-up. Following is a description of how the check processing system works with the Payment Processor, ACH Network and Check 21 Image Exchange Network all together to help the merchant collect payments.
These invoices need timely processing and many departments are involved in the verification and approval process.
The invoice recognition module employs ExperVision® ‘s world champion OCR to process data such as vendor information, product items and prices, account number, amount, date, etc. The traditional way to manage out-of-office activities is to use paper work-orders and worksheets, which leads to many problems such as difficult to track the workflow information, misreading information on paper, and unable to quickly search and index wanted information on worksheets. We offer end-to end admin solutions for small and large insurance companies and TPAs, processing over 15 million transactions per year worth $7 billion, saving them over $15 million.


Even if we assume that all the payers and providers are migrating to ICD-10 (desirable, but hardly a pragmatic situation) on Oct 1st, 2013 (compliance date), dual processing is going to be required for some adjusted claims and inpatient claims. The Centers for Medicare and Medicaid Services (CMS) has mandated the Electronic Data Interchange (EDI) 837 Standard for processing health care claims with data such as billing, demographic, and diagnosis information. HIC required The client to convert all types of claim forms to electronic forms daily, and input the data in a standard format for the HIC declaration analysis database. Worklist and Clinical Messaging are also included to help streamline communications between the clinicians and the supporting staff.
The agents then establish the request authorization and help retrieve the data in minutes for the caller.
We follow and enhance client’s systems and processes with our experience of the industry.
These include converting paper-based checks into electronic transactions, processing transactions through the ACH network or Check 21 image exchange network, automating returned check re-presentment, generating real-time reports and supporting proactive risk management. Statistics show that, 96% of the invoices are on paper and have to be processed manually, which makes the cost as high as $10.15 per invoice. To guarantee not missing any qualified candidate, it takes a significant amount of time and effort to include the information on paper in the human resource software system. These problems generally degrade workflow efficiency, waste resources and destroy customer satisfaction. In this blog, we discuss challenges, ideas, innovations, and solutions for the healthcare economy. The HIC operators cannot pay the health insurance until analyzing and verifying the declared data compatibility and removing the possibly inaccurate data, which assures the payment is on time and avoids the loss of possible scams. Therefore they began searching for a Forms Processing System (FPS) to process the HIC claim forms using OCR to achieve most of the data processing automation, enhancing the processing speed, assuring the accuracy and timeline and saving the data processing costs.
The immensely as the authorization process has become very effective and patient care has improved substantially. With manual processing, mistakes such as incorrect calculation, duplicate payments, inability to transfer to correct department and even the loss of some invoices can occur. All medical providers must adhere to the standards of their respective states for filing claim information.The Electronic Claims Submission ProcessEach electronic claim file is subjected to various edits to before being submitted. As a result we save healthcare service providers and healthcare management companies valuable practice time and resources.
These edits validate that the file conforms to the EDI 837 file format and that the file would not be rejected by the state. After each EDI submission, an acknowledgment receipt is sent to the submitter confirming a successful submission or a list of failed submissions.Electronic claims processing software used in preparing the claim information should include fairly complex business rules, and must reflect a good understanding of the most recent HIPAA rules. In addition to conforming to HIPAA rules, the electronic claims processing software must also adhere to several privacy and security rules. Moreover, since HIPAA rules may change, the software should have the ability to easily update itself.Software Implementation TechnologiesElectronic claims processing software application have traditionally been implemented using Client-Server architecture so that facilities can locally scrub and transmit their electronic claims or transmit their claims to a clearinghouse.



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