Case Study: Insurance Claims Processing

 

Challenge:

Elliot Health System (EHS) is the largest provider of comprehensive healthcare services in Southern New Hampshire. The cornerstone of EHS is Elliot Hospital, a 296-bed acute care facility located in Manchester, New Hampshire. Established in 1890, Elliot Hospital offers Southern New Hampshire communities caring, compassionate and professional patient services. is a designated trauma center for the greater Manchester area, and has one of only three Level 3 Neonatal Intensive Care Units (NICU) in the State of New Hampshire.

In the world of hospital billing, the Explanation of Benefits or EOB is the final word on how a claim was settled by the patient's insurance provider. When Elliot Health Systems services are provided to patients, claims for the payment of services are submitted to third party payers (insurance companies, government agencies, 3rd party administrators, etc.) 

Payments are made to Elliot in the form of a check or electronic funds transfer. Accompanying the payment is an itemized report of the claims included in the payment. Typically, several patients to several thousand patients are paid with a single check. The itemized report is then used by Elliot billing staff to post the payments to each patient's account. Often the amount received doesn't fully satisfy the outstanding balance and requires the hospital to either submit a secondary claim or bill the patient directly for the difference. 

The challenge for Elliot was to create a filing system that would allow them to easily retrieve an EOB that lists multiple patients in order to submit a secondary claim or to perform collections for the unpaid balance for a single patient. In addition, the system needed to allow the billing operator to take the EOB document and remove any HIPAA regulated information, like other patients' data from the page before submitting it to the insurance company or patient.  

Solution:

Recordsforce president, Bill Becker, met with the Director of Patient Billing, Jim O'Connor and together they came up with a solution that would enable Elliot Health Systems to build a process that minimizes the labor required to file and retrieve EOB documents and satisfy tricky HIPAA regulations. 

Over 70,000 claims per month are transported to Recordsforce’s production facility three times a week by Recordsforce’s courier, where the documents are scanned, OCR’d, and indexed by the assigned batch number. The digitized records are then uploaded to Elliot Hospital’s content management system for long-term retention and retrieval. This significantly reduces the labor required to organize, retrieve, and reprint these documents

Result:

Implementation of this solution allowed Elliot Hospital to eliminate over 75 full file cabinets of paper from their billing department, and move forward with a paperless solution. The faster retrieval and electronic clean-up capabilities made secondary claims processing 75% faster than traditional paper processing. Other results include:

  • Freed up office space
  • Reduced efforts
  • Streamlined retrieval process
  • ROI in less than 6 months
  • Increased security
  • Enhanced visibility and control
  • Ensured prevention of natural disasters