One of the largest HMO in the Philippines was processing Patient Claims from employees of local companies providing Health benefits to their employees. The challenge was how to reduce the Claims cycle from one month to two weeks. This will ensure prompt payment to hospitals and doctors within two weeks or less of employee availments.
In addition, companies availing of HMO services require frequent reports on employee availments to monitor the efficiency and usage of HMO provider.
Patient Claims from different hospitals resulted in 10,000 claims per day or an average of 60,000 records daily. These records must be moved from one Claims processor to another and must be reconciled with the payment made to various hospitals. Problematic Claims such as those with incomplete documents can be held up for days and must be monitored throughout the Claims cycle.
The HMO service provider, in conjunction with Infomax Account Executive proposed a document imaging and viewing system composed of InfoCapture, Kodak Scanner and InfoView to allow Claims processors to view pertinent records from a Server. Thus eliminating the movement of paper and minimizing storage space.
The new process enables documents to be stored digitally saving on office space and are readily available to each Claims processor or Customer Service Representative. Processing speed is increased enabling quick payment to Hospitals and faster response to client’s information requests.