Wyoming Department of Health
The Wyoming Department of Health (WDH) needed to improve its Medicaid claims processing, which involved too many manual steps, and modernize their processes, mainly around forms CMS-1500 and UB-04.
The WDH had been dealing with several process inefficiencies. Each claim in their benefit management system took about five minutes to process and required a lot of manual data entry. They needed to upgrade their system to eliminate repetitive manual steps and speed up the Medicaid claims processing from end to end.
Despite the successful transition to mostly electronic records, the system still had to comply with a state mandate to accommodate paper submissions into the Medicaid claims process. They needed a data capture system that could quickly scan paper records and automatically extract the data with great accuracy and get the information into the claims system.
Paper records were only part of the challenge; they needed a solution that could process data from multiple electronic sources using the same programmatic rules and logic as the paper records.
One of the main challenges was the manual work required to get data from paper-based claims into the healthcare platform. The system is designed specifically for Medicaid claims management and is increasingly popular with state Medicaid offices. The system manages claims and provider and member information but it’s not a document scanning solution with Optical Character Recognition (OCR) capability, document type recognition, or data extraction capabilities.
To process claims and perform other customer-related tasks, all forms had to be pre-sorted into separate batches of different document types, including color and non-color documents. Claim numbers and other details had to be manually entered into the system.
To automate the Medicaid claims process, the WDH needed one system that could manage any input type, paper or otherwise, and get the customer data into the system quickly and accurately.
Additionally, it was clear that Kodak Info Input Solution offered more capabilities at a significantly lower price than the competition. Info Input was the best product at the best price, enabling centralized data input and management from multiple sources and types, right from a browser. The Info Input API makes it easy to connect directly into the system’s web service.
All these technologies are now working in concert to accelerate the Medicaid processing and management system in Wyoming. For paper-based claims, the Kodak scanner captures the data and sends it to Info Input, which automatically identifies the data type and extracts, classifies, and validates the data for successful delivery into the web service.
Info Input checks each record to ensure the billing provider is valid and automatically rejects claims that meet certain invalidation criteria. For example, data is extracted from Medicaid claim forms CMS-1500 and UB-04 and processed quickly, often without any manual intervention. The data is indexed and placed in a verification queue to validate the extracted data.
The system user then sets a confidence threshold score so that any subsequent forms that meet or exceed that threshold can be processed without human verification. If a claim is rejected for some reason, it’s sent to the system for exception handling.
The ability to perform these checks before the data is delivered to the system is a critical piece of the success story. Automating the validation process is a major time saver for everyone involved.
Info Input Overview Video
By partnering with Kodak Alaris, the Wyoming Department of Health has successfully modernized its Medicaid processing system. Instead of having to manually sort claims into separate batches, employees can now load documents of any type into the scanner with no pre-sorting of any kind. There’s significantly less upfront work to get claims into the system and very little repetition and re-work, which has been key to improving provider and member service, operational efficiency, and total processing time.
There’s no need to manually enter claim numbers and other details. In fact, there’s hardly any manual work at all – everything is preconfigured and then automated for optimal efficiency. The ability to perform these checks before the data is delivered to the system is a critical piece of the success story. Automating the validation process is a major time saver for everyone involved. The time required to process a claim has been reduced by half, which has significantly improved the experience for employees, providers, and members alike. The new process has accelerated business efficiency for everyone involved.
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