A wholly owned division of Intelliscan, Inc.

FOR IMMEDIATE RELEASE

Magellan Specialty Health

Application: Medical Claim Processing

Magellan Specialty Health (MSH) is a leading, multi-state, specialty physician management company dealing with over 25,000 physicians in 25 different specialties. As a third-party administrator (TPA) for 13 insurance carriers, MSH processes approximately 250,000 specialty claims monthly (e.g. heart surgeries) to determine the proper way to pay the claim.

Before an automated solution was developed, the medical claim forms, received by mailed, were opened, date stamped, and sorted and batched by physician specialty. The forms were keyed into the claims database and filed. The system would perform adjudication to determine the validity and proper payment of the claim, and using its own intense logic, would generate a report that selected out-of-the-ordinary claims for review. These claims would then be manually pulled from the files and sent to a review panel made up of 150 physicians.

In order for MSH to continue to grow and improve customer service, it began working with Digital Documents, a California-based VAR specializing in forms processing, and Verity, Inc., a forms processing solution provider, on an automated solution The MSH implementation now includes Cardiff’s TeleForm Elite Multi-User Software, Cardiff’s MediClaim Module, a high speed Kodak 7500 Scanner, EMC Documentum’s Application Extender Document Management Software and a Plasmon Optical Jukebox.

“To ensure the success of Magellan’s system, we brought together a solution comprised of Vendors who represented the most proven and technologically advanced products on the market”, said Bruce Genger, V.P. Sales of Digital Documents.

Now when claims arrive, instead of being stamped and sorted by physician specialty, they are separated into batches of high and low quality for interpretation. The poor quality forms are still scanned for image archiving and then hand keyed in. The rest are processed by TeleForm and verified using the MediClaim Module. Once a batch is verified it is exported to Microsoft SQL Server, and then it is converted into the National Standard Format (NSF) 2.0 for uploading to the main claims database. The system also automatically creates an index file for the images.

For MSH, the benefits are tremendous. Most important, there is absolutely no documentation loss. Every claim is automatically scanned and indexed and can quickly be found. When a claim needs to be pulled for review, instead of searching through paper files, the image can be quickly located and printed. The increased productivity, from 150 claims per person per day to 400 claims per person per day, has saved 20 full-time staff positions. Document retrieval is significantly faster, and turnaround has been reduced from one week to three days.

Bruce Genger adds, “Having the ability to offer our Client’s a Form Processing Package that simultaneously reduces manual data entry and captures the image and key indexes for a Document Management Software is a tremendous sales advantage, added Bruce Genger. Our Client’s Form Processing Return On Investment Analysis Average is under 8 months. After evaluating Readsoft and OCR for Forms, we selected TeleForm for it’s flexibility, price and performance advantages.”