Despite the general consensus that we are living in a digital world, organizations are still getting swamped with paper. To learn how to handle your paper pileups, you would do well to study the solutions put in place at banking institutions, medical providers, and insurance companies. Because of mandates about document retention and the standardization of information, these verticals tend to be hit hard with paper.
For benefits processing departments at insurance provider Pacific Life & Annuity Co. (PL&A), the hit comes at the tune of 1.8 million claims-related forms and documents per year. A subsidiary of insurance giant Pacific Life, PL&A has to index claims by type before imaging and archiving them. Imaged documents often have to be routed to adjudicators, who approve claims or request additional information. Then, the imaged documents and extracted data must be entered into PL&A's FileNet document management system and into the mainframe. Enabling each step is Captiva Software's FormWare software.
Scan, Scrape, Route
PL&A accepts claims and correspondence by mail, fax, and EDI (electronic data interchange). Before it brought in FormWare, PL&A staff members manually sorted and stored the mailed and faxed documents.
Now, with the Captiva system in place, EDI documents are directly pushed to the FileNet archives. The rest are scanned on a Kodak scanner before FormWare reads the images and categorizes the documents by type (e.g. medical claims or dental claims). FormWare routes verified documents, as well as key information extracted from them, to the FileNet system and to the mainframe. Once there, the information and documents can be distributed to the workflow queues of adjudicators and claims processing staff.
Although letters follow different workflow routes than do medical claims, correspondence in response to PL&A information requests also moves through the OCR (optical character recognition) and data extraction process. "We have created letters called 'pend response forms' on which we provide claim status information and request additional information," says Stephanie Lopez, manager of claim support services for PL&A Group Employee Benefits Operations (GEBO). "The data captured when they return these forms is highly standardized, so we get a high accuracy rate when we do forms identification." Unlike the medical claims and pend response forms, the scanned dental claims - much less standardized - bypass OCR to be processed through manual data entry before being pushed to FileNet and the mainframe.
Make Sure Your Data Is Clean
With the document imaging and forms processing solution in place, PL&A reports a 17% increase in productivity associated with processing documents. And, it has achieved those gains even while it occasionally - and deliberately - slows the process to maintain accuracy. "We have many checks and balances built into the system," says Robert Gutierrez, PL&A GEBO's supervisor of benefits systems. "Connected to the data fields are tables that we use to verify information processed through OCR or manually entered. When an invalid character or code has been entered, the system automatically prompts an operator to review and re-enter the data. Plus, all documents with unbalanced totals or invalid member ID numbers are automatically flagged for additional verification."