Front-End Processing

Health Claims Entry Administration Services

DST Health Solutions' front-end processing services enable you to capture and support new business more quickly and effectively - and deal with fluctuations in existing workloads more efficiently - without the investment in personnel, facilities and technology usually associated with administering the process in-house.

Regardless of whether your organization is a health insurance plan, provider-sponsored organization or third-party health benefit administrator, you can direct your healthcare claims to DST Health Solutions for scanning, imaging and data entry through optical character recognition (OCR) and sophisticated entry-from-image procedures. DST Health Solutions can perform these services for you regardless of the type of claims adjudication system you are currently using. Specific DST Health Solutions services offered include:

• Mail receipt and processing
• Claims sorting and classification
• Document imaging
• OCR/data capture/repair
• Quality assurance
• Claim archiving and storage
• Electronic claim management

Document types supported include HCFA-1500, UB-92, dental claim forms, other claims and explanations of benefits, enrollment applications, written inquiries and claim tracers.

Process Overview
DST Health Solutions receives, opens and sorts mail using high-speed equipment. Batches are scanned within two business days of receipt at DST Health Solutions. DST Health Solutions creates an electronic data interchange (EDI) file for every piece of paper. DST Health Solutions then uses OCR technology for a portion of scanned and indexed claims to convert character images into data that can automatically populate fields in the claims adjudication system.

Claim forms are typically held in an onsite storage facility for 90 days. After that, they can go to offsite storage, back to the client or be destroyed according to client requirements. Using optional technology, clients can view and circulate electronic images of claim forms from a PC at their desk rather than routing bundles of paper claims and folders.

DST Health Solutions' system for quality assurance (QA) allows us to evaluate the accuracy of data entry personnel and other workers, as well as review the audit trail of any item processed. Our system keeps a complete history of every field of every claim processed and all claim forms. The history records exactly what information each worker has entered, allowing our QA staff to collect samples of any type of claim processed and any operator's work. We can then compare work performed with the original claim form, mark errors, make corrections and record comments. This powerful and effective QA system assists our operational management team in consistently monitoring and adjusting the accuracy level of claims data input.

To more about Front-End Processing, contact us at inforequests@dsthealthsolutions.com.