ClaimPack

ClaimPack: A HCFA 1500 and UB92 Processing Solution

ClaimPack helps you reduce operating costs, increase accuracy and improve customer service.

In medical claims processing, managing a mountain of paper forms is all in a day's work. To minimize the costly and time-consuming process of manually handling thousands of claims or more each day, leading companies use ClaimPack from Captiva Software Corporation.

ClaimPack is designed to automatically process HCFA 1500s and UB92s, which are nationally recognized medical claim forms. Despite the advantages brought by a common design, processing these forms is still a difficult task. Over seventy variations of the HCFA 1500 form alone have evolved over the years, none of which is technology- friendly. To make matters worse, different providers enter information in different ways, often incorrectly—and the rules governing what data will be accepted are voluminous and ever changing. These complexities make it easy to see one of the reasons why medical costs continue to soar.

There is a better way. Using the latest developments in scanning, image processing and recognition technologies, ClaimPack automatically reads the information on these forms; analyzes, corrects and validates the data; and enters it into your workflow or database management system. As a result, you can reduce manual data entry costs, increase accuracy, shorten processing times, and ultimately, improve customer service.

Saves Money Using Captiva's award-winning FormWare software as a forms processing platform, ClaimPack minimizes operator intervention by automatically reading up to 90% of required HCFA 1500 and UB92 fields. In addition, ClaimPack controls and prioritizes processing to maximize efficiency. Simply put, ClaimPack lets you perform more work with fewer people. The result is improved productivity—and a better bottom line. Speeds Processing By automatically capturing information from HCFA 1500 and UB92 forms, ClaimPack shortens your processing time significantly. And that means your claims will be adjudicated faster and payments distributed more efficiently.

Increases Accuracy ClaimPack reads HCFA 1500 and UB92 fields with accuracy rates as high as 99.5%. ClaimPack's unique rules feature authenticates diagnostic codes, performs math validations and even verifies city, state and zip code information. And using a variety of look-up tables including procedure codes, provider numbers and physician ID, ClaimPack minimizes the need for manual error correction. Improves Customer Service With instant access to data and images, your customer service team can respond to queries faster and more accurately than ever before. So as your productivity rises, so does your customer satisfaction.

Streamlined Front-End Processing
• Reads over 75 variants of the HCFA 1500 form without presorting
• Processes red dropout forms, black non-dropout forms, and faxed red dropout forms
• Handles difficult form variations through dynamic form removal and detail area processing
• Processes multiple-page claim forms and attachments
• Point-and-click selection of fields, formats and recognition settings Highly Accurate Recognition
• Reads data using voting and industry-leading character recognition engines
• Captures complete data from Field 24 rows, while avoiding comment lines and stamps
• Corrects Field 24 misalignments, even when spread over two lines
• Recognizes signature presence Comprehensive Business Rules
• Offers a variety of standard and optional lookups and validations, including:
• Diagnostic (ICD-9) and procedure code (CPT) lookups
• Provider number and location, place of service, type of service and physician ID number validation
• Date range validation
• Arithmetic checks of balance due, amount paid and total charges
• City-state-zip validations, with optional PerfectPost USPS database
• Optional eligibility and provider database checks
• Supports customer-specific business rules through fully integrated VBA environment
• Monitors performance statistics, including field acceptance and operator statistics
• Year 2000 compliant Industry-Leading Correction and Verification
• Uses FormWare's award-winning user interface to validate characters and fields
• Provides field, form and batch level processing
• Provides in- and out-of-context reject repair and multi-pass verification
• Supports key from image for difficult fields, forms or attachments
• Supports blind double-keying of critical fields
• Displays attachments while keying or correcting claim data Industry-Standard Exports
• Formats NSF 3.1 and UB92 5.0
• Configurable ASCII output file formats
• Direct ODBC database connectivity option
• Workflow & document management systems

Captiva Software Corporation, 10145 Pacific Heights Blvd., San Diego, CA 92121. Tel: 858-320-1000; Fax: 858-320-1010.