Q&A | November 1, 2012

A Healthcare Payer's Guide To Lean Document Processing

Mark Smith

Lean methodologies are geared toward continuous process improvement and encourage eliminating waste and reducing defects. These practices originated in the Japanese manufacturing industry, but have since been used to improve countless business processes in companies around the globe. In this Q&A, Mark Smith, Director of Strategic Alliances at OPEX Corporation, shares his advice on how to apply lean concepts to the document processing operations of health insurance companies.

Congdon: Is managing paper documents still a significant challenge for health insurance companies?

Smith: Absolutely. While studies show that 75% to 85% of the claims health insurers process today are electronically transmitted, the remaining 15% to 25% continue to enter these organizations as paper documents. While they may constitute a significantly smaller percentage of the overall claims received, these paper claims generally represent the “uglier side” of claims processing. For example, they are the handwritten or dot-matrix claims forms submitted by small doctors’ offices or the long multipage forms that include added documentation or correspondence. This 15% to 25% of paper claims can take longer and be more costly to process than the 75% to 85% of electronic claims, largely because of the way these documents continue to be processed by health insurers. In addition to claims, of course, insurers receive multiple other forms and paper documents in the mail related to eligibility, enrollment, credentialing, and more.

Too many payers continue to use dated manual processes to manage these paper documents. These practices are rife with wasted steps that prolong turnaround time and introduce risk into the process.

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