Claim
Processing
CLAIMS PROCESSING
To serve the clients of claims processing system with the
utmost care and efficiency, the Organization needs to settle
claims on their insurance within 10 days to avoid penalties.
With approximately 7 million claims holders globally in the
Organization's database, each patient receiving care, has the
possibility of bringing anywhere from one to 19 forms
available to the center for processing which includes standard
and non-standard, Medicare, dental, medical and voucher forms.
The volume is tremendous, and the customer knew that
outsourcing the data entry of claims would be very critical to
meet the 10-day deadline.
Workflow
How we Work
On a daily basis, images are received from a “image” team
at the Organization, and uploaded to thuriam's offshore
facilities. Images are then distributed to thuriam's keying
sites. At the completion of the data entry process, thuriam
electronically sends the data to the Organization to upload
into their system. This key data entry process consistently
delivers data to the Organization in less than 36 hours, and
thus they can easily meet the 10-day deadline to efficiently
serve their patient community.
The Organization is thrilled with the level of services and
quick turn around times offered by thuriam. Claims are settled
within 10 days, and a higher percentage of claims are now
automatically adjudicated without delay resulting in quicker
payments to providers and insurers. thuriam's quality
measurements, established through our Total Quality Management
process, have exceeded the Organization's requirements for
months, and they have seen significant improvements to the
already short turn around times. In addition, thuriam worked
with the Organization to determine the precise output data
needed and worked to address all the issues and concerns in
less than 18 hours from receipt.
Over the course of the few years, thuriam has worked with
the Organization to deliver a quality end result. thuriam has
reduced errors in such areas as scan quality, denied claims
and illegible data. With guaranteed accuracy rate of 99.3%.
By outsourcing your claims processing to our company, we
will be able to process claims faster and more cost
effectively than performing the work in-house. Your bottom
line will benefit from:
Learn more about our Global Sourcing and Service Delivery
Guaranteed 48 hour processing time irrespective of the
claim volume.
Guaranteed accuracy levels exceeding 99.3%.
Real-time web based Work in Process reports.
Guaranteed capacity of programmers, processors and data
engineers to meet your impromptu requests.
Quality and process control through ISO9001 and Six Sigma
methodologies.
We are able to convert different claim types in less than
48 hours with a 99.3% or higher rate of accuracy. We pride
ourselves in being one of the only industry providers to
process Explanation of Benefits, payments, enrollment and
referral documents. And with the capability to reduce your
adjudication costs by up to 45% we have established ourselves
as the leader of Business Process Outsourcing in the claims
processing industry.
We view the claims process event as entirely linear. A
claim comes into the facility through the mail. It is
received, opened, batched, grouped and scanned by us. Next,
the scanned claim is electronically sent to one of our in
house data capture facility, where the claim is keyed and
converted into the customer specified output. The output data
is then downloaded into the customer's desired adjudication
system, where we will adjudicate the claim according to the
specific rules of the insurer's plan.
After adjudication the claim can be uploaded into a
document management system, or into our on-line storage
solution.
Breaking Down the Process
Outsourced Claims Receiving Units, can instantly save
insuring organizations precious time and resources. We receive
your mail at our facilities or onsite at your location.
Document Scanning
Our vast array of resources allows us to image claims
either at the customer location or at one of our strategically
placed facilities.
We also provide premier document security. While your
documents are with us, we:
Account for each and every claim coming out of your
facility.
Establish a tracking convention unique to your
organization's business rule, allowing us to guarantee
deliverables.
Once the claim is digitized, the image is routed to our
data capture facilities. Each unique image is tracked
throughout our quality intensive conversion process. Utilizing
our Quality Certified Processes and TQM methodologies we
guarantee quality levels exceeding 99.3%.
The converted output is then downloaded into the customer's
system. We will then remotely access the customers' system and
manually adjudicate all claims that are not accepted through
auto adjudication, according to the customer's business rules
specification and plan specification.
Online Document Storage & Retrieval
Our overdue solution for the claims processing industry.
The prevalent need to store, retrieve and archive large
volumes of paper and data, requiring access by several
internal and external sources, has organizations scrambling to
stay afloat. Additionally, document management creates a
virtual customer service department, so you no longer have
multiple disjointed customer service locations, but rather one
single, virtual platform all customer service representatives
can utilize.
Quality
We very strongly feel that quality and accuracy are our
primary importance. And, even though turnaround, cost and
efficiency are important, quality is always our overriding
concern. This is why we have adopted extremely redundant
quality control procedures.
Our quality systems and corporate operations and methods
are high class, which are trusted by the top organizations for
their ongoing business. Our commitment to quality is reflected
in numerous satisfied repeat customers for past years.
We have established effectively implemented quality systems
and procedures, which were developed by the founder with more
than 10 years of data processing experience.
The first step in achieving highest quality is training. We
always assign dedicated team of people to work on every
project. All people go through a intensive training program
before they start working on any new project. A dedicated
project manager is also assigned for the project to manage all
the communications with the customer and the data processing
team.
The high level of consistent quality is achieved by
maintaining all data documents received for processing. When a
job is received it is batched and each batch of documents is
assigned a batch control log. Operators log out batches for
keying and verifying.
Quality Control is accomplished by continuous key operation
of selected batches to assure guaranteed accuracy. Key
verified work using double keying is guaranteed at an accuracy
rate of 99.995%. Unverified work is guaranteed to be 97% - 99%
accurate. Of-course, we always strive for 100% accuracy.
Custom error checking programs are written for every
project to improve quality. Database lookups and are
implemented as part of keying process whenever possible to
achieve the best quality.
All projects are quality controlled by Quality supervisors
who randomly check operators for continuous accuracy. New
operators are checked 100% until they become familiar with the
project and meet our quality requirements.
Benefits of Solutions offered by Thuriam
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Lesser staff and space required to manage the front-end claims processing |
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Our Group experience with latest claims processing transaction sets |
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Provides a known cost for expanding business services |
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More accurate processing & front-end eligibility verification (less work in adjudication) |
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Ability to concentrate on core business & customer satisfaction |
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Security of having multi-site processing capabilities |
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Security of having off-site file backup |
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Improved workflow efficiency and communications with claims processing documents. |
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