HMO Claims Management and HIPAA

Western Health Advantage (WHA) is a full-service, not-for-profit health care plan operating in Northern California in Sacramento, Yolo, Solano, Western El Dorado and Western Placer counties. They offer a variety of health care products and services to meet the needs of patients and employers. WHA features some of the region’s premiere medical professionals, giving their members access to more than 800 primary care providers and more than 1,400 specialty care providers. WHA also maintains a complete network of specialty physicians who have admitting privileges at some of the top facilities in the region.

The Process

The Problem

Like any other healthcare organization, Western Health deals with an endless flow of paper everyday. The main focus of the initial project was claim forms. The company had chosen to outsource the scanning of these forms to a vendor, and initially this was a great solution. But as claim volume increased and their membership began to grow, the turnaround time for scanning claims was up to three days and the delay was unacceptable.

Along with claims, many other departments had expressed interest in scanning and maintaining documentation for compliance reasons, as well as ease of access.

“With the time lag and continually increasing issues with the internet availability, my staff was frustrated with the current application. The program itself was easy to search and manipulate the documents as needed. Once we found out that we could purchase the Alchemy application for under what we were paying the third party vendor, it became very obvious to me that this was the way to go. My staff was thrilled at the idea that claims could be scanned and available to view on the same day without the application being unavailable.”

Pam Colin
Contracts Manager

Solution Requirements

As Western Health looked at their growth rate, they knew that there had to be a more efficient way of dealing not only with claims, but also with paperwork from other departments, such as compliance, COBRA, eligibility, HR, legal and accounting. They needed an overall solution that was flexible enough to implement quickly to solve their claims issues, but could also be easily expanded to other departments.

“What we were looking for was not just a software solution to minimize paper in the office, but a partner that could grow and change with our needs with regard to HIPAA and confidentiality. Someone that would be in this with us for the long term,” said Noelle DeBortoli, Manager of Administration and Project Lead.

The PSIGEN Solution

Capture Software

13 PSIGEN PSIcapture Enterprise Workstations

Content Repository

OpenText Alchemy

Scanners

7 Konica Minolta Scanning Copiers & Fujitsu Scanners

Western Health Advantage initially invested in Open Text Alchemy and a Fujitsu Scanner, with full intent of utilizing their Konica Copiers as on-ramps to the Document Management System. They quickly found that they required a more advanced capture workflow, especially with regards to quality assurance, standardization and efficiency. With the implementation of PSIcapture, they were able to have multiple users participate in the scanning and capture workflow, allowing quality control of both the entered data on the claims and the image quality.

They immediately found that the PSIGEN product provided a major reduction in the amount of time spent scanning and indexing claim forms, almost by half. PSIcapture spread virally throughout the organization, and today almost every department within WHA utilizes PSIcapture: Claims, Eligibility, Finance, HR, Compliance and Administration. They have even integrated PSIcapture with their eCopy Scan Stations to provide enhanced scanning capabilities through scanned file routing and processing.

Conclusion

The broad feature set and flexibility provided by PSIGEN’s PSIcapture gives it the ability to seamlessly blend into any scanning and capture environment, regardless of the document management system used. It excels within diverse environments like WHA by allowing the use of various scanning devices to meet diverse user needs. The licensing model allows organizations to start small and scale their imaging infrastructure to serve both centralized and distributed scanning operations for multiple departments, and any number of end users.

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