CapturePoint for Claims
An Award Winning Solution
CapturePoint for Claims is an advanced document and data capture solution that optimizes processing of CMS 1500, UB-04, and ADA 2006 health insurance paper claim forms. Since 1999, R2K has delivered award winning claims capture solutions to health insurance and property and casualty companies nationwide.
Increase Speed and Accuracy while Reducing Costs
R2K’s value-added systems integration leverages technologies from leading software vendors to help customers increase business productivity while reducing costs. Documents are scanned,classified, and exported to the customer’s content management repository.
Claim data is automatically extracted, verified, and delivered to the claims management system. Automatic validation of data is performed through lookups against external data stores, cross-field comparisons, mathematical calculations, and customer-specific rules to maximize accuracy while simultaneously minimizing the need for manual processing.
Benefits of CapturePoint for Claims
- Improves claim data accuracy and maximizes auto-adjudication rates
- Reduces data entry cost through the use of OCR and validation rules
- Speeds the front-end claims capture process
- Flexible architecture easily adapts to dynamic business requirements
- Enables easy work distribution
- Supports rule and process flow
- Variations for multiple LOBs
- Improves regulatory compliance and document security
- Proven ROI
Grow Your Business with R2K’s High-Performance, Scalable Architecture
From one thousand claims per day to tens of thousands, CapturePoint for Claims is completely scalable and can be implemented to suit any volume requirement, no matter how large or small. Other corporate documents can also be captured providing a single point of entry solution for all of your incoming information.
Case Snapshot
A Fortune 500 Health Insurance Company
The Challenge: Improve employee productivity, decrease processing time and increase auto-adjudication rates for front-end processing of more than 22 million CMS 1500 and UB-04 paper claims each year.
The Solution: R2K’s front-end capture and OCR solution using CapturePoint for Claims.
Business Benefits: ROI in 11 months, 15% reduction in suspense rate, 160% increase in productivity, 40% reduction in cycle time, and 65% automated provider coding with 100% accuracy.
Complete Flexibility
CapturePoint for Claims is a vertical solution allowing you to customize “out of the box” claims processing functionality, including pre-defined electronic forms, process flows, validation rules, and lookup tables. Rules are easily modified through a point and click interface or further customized using standard development tools. CapturePoint for Claims provides ultimate flexibility when determining the level of rules processing and real-time edits performed prior to submission to the back-end claims system. Choose to maximize the auto-adjudication rate through comprehensive rules and edits, defer error resolution to the suspense process, or elect for something in the middle – it’s your choice.
CapturePoint for Claims Workflow and Key Features
Complete Vertical Solution for Health Insurance Claims
- Electronic versions of CMS 1500, UB-04, and ADA 2006 forms
- Pre-configured capture of all fields
- Single, multi-page, attached and non-standard claim support
- Dual OCR voting to maximize accuracy
- Extensive rules and edits
- Lookups for member, provider, diagnosis code, procedure code, modifier, POS, etc.
- Support for various export formats including ANSI 837
- Productivity reports and job monitor
Industry Compatibility
- Microsoft Windows (multiple platforms and versions)
- Direct integration with many enterprise content management products
- Support for leading scanners
- Oracle and SQL Server database support
- Multiprocessor capable
- Server-side runs as Windows services
Business Rule Configurability
- Extensive library of standard claims processing rules
- Point-and-click interface for rules management
- Extensible rules via standard development tools
- Access to external data stores
Single-Pass User Verification
- Review of fields flagged by business rules and low-confidence OCR characters
- Real-time edits and table lookups
- Auto-advance to bypass validated fields
- Single key validation override
- Hotkeys for common operations
- Full-page and field snippet image display options
- Automatic field highlighting
- Rescan and supervisor escalation capabilities
- Key from image capability available if required
Click here to watch the “What’s New in Medical Claims Capture” webinar.
