CASE STUDY - Blue Cross Blue Shield of Arizona -Improved Document Management

Blue Cross Blue Shield of Arizona (BCBSAZ) has been one of the state's largest health care insurers for over 60 years,. BCBSAZ is an independent and locally-managed company dedicated to serving over 700,000 customers with a wide range of health care plans serving virtually every market segment.

Over the past decade, BCBSAZ began to face increased technical and organizational challenges in order to keep up with growing business opportunities while adhering to increased government regulations. More than 20,000 paper HCFA and UB-92 health claims flow through the company's Phoenix-based mail room every day, putting significant pressure on their claims processing operation to keep up with the volume. In addition, the Phoenix office and four other regional offices receive a wide variety of related documentation including enrollment applications, correspondence, super bills, and test results. All of this documentation requires imaging, data entry and distribution.

In 2000, after a long selection process, BCBSAZ implemented Datacap Health claims capture (HCcs) integrated with a FileNET image management system. To handle the installation and implementation, a St. Louis based firm, KnowledgeLake, Inc., was added to the project. This nationally recognized professional services company and value added reseller played a key role in the success of BCBSAZ's project. Karen Abraham, Chief Financial Officer at BCBSAZ, points out, "We have to work with the selected vendor for a long time so we really needed to make sure we picked the right people, the vote was unanimous."

Challenge
In the last ten years, BCBSAZ had accumulated various "home grown" systems to handle the increasing volume of paper. In 1993, BCBSAZ added OCR (Optical Character Recognition) technology to their microfilming process. While the OCR technology was an improvement, it was still limited in the type of claim it could process. Another problem was that the documentation stored on microfilm did not allow the user to immediately access historical documents. It took anywhere from two to three days to respond to a customer call since the documents had to be retrieved from the microfilm, printed and then routed.

As the years went by, it became increasingly difficult to continue supporting the microfilm process. BCBSAZ recognized that imaging and OCR technology had come a long way so in 1999 they assembled a task team to implement a new imaging technology plan for document storage and claims processing. The team developed a list of goals which became the template for identifying and selecting the solution. These goals included developing a common medical and dental claims data entry user interface, improving customer service by reducing input time on claims and providing users desktop access to documents allowing a faster response to customer inquiries. The new system would also reduce operating expenses by enhanced throughput, reduced training time and by replacing obsolete technology.

Solution
With the size and scope of the project, BCBSAZ assumed that they would need several capture solutions to integrate with the organizations diverse back end systems. However, when Datacap demonstrated that its HCcs imaging and recognition software could easily be extended to capture and route all of their documentation through one input and with the expertise that KnowledgeLake had with this type of implementation, the choice became easy. "We felt the other proposed solutions were trying to stuff our needs into an out-of-the-box solution," says Susan Canter, Manager of ODC/Records Management, "with KnowledgeLake, we were able to customize the program to fit our specific needs."

The solution begins with four Kodak scanners at the Phoenix office – one outfitted with a red bulb for HCFA and UB-92 claims. After scanning, Datacap HCcs receives the images and its Dynamic Recognition Client "cleans" them up. Then it applies dual OCR recognition before submitting them to a series of business rule validations to determine if the data is accurate. Following this background processing, low confidence characters and failed validations are highlighted, making it easy for operators to fix a claim in seconds.

After verification is complete, claim data is uploaded to BCBSAZ's routing software which sends claim data to one of four different adjudication systems. Claim images are stored on a Hewlett Packard optical jukebox while non-claim documents are indexed for storage and forwarded to the proper department. The FileNET image management system provides the access and permissions for each department to use data or images as they need.

Results
BCBSAZ has made significant progress on all the goals it was seeking to accomplish. As of March 2001, all paper documents are being scanned – completely phasing out microfilming. This transition substantially reduced weekly retrieval requests from 5,000 to 650, downsized retrieval equipment by 75% and reduced number of retrieval stations from six to two. This step alone had a project benefit of over $196,600. As a result, users gained an intranet-based web browser for document search/retrieval which allowed BCBSAZ to view documents while speaking to a customer – eliminating up to a three day response waiting period. In addition, regional offices can now view correspondence online simultaneously which reduced courier costs and paper handling.

In Claims Processing, users helped define screen layout and shortcut functions. "Another contribution to the projects success was that we kept so many people involved and informed. All of our test users supplied feedback on a regular basis, helping define the project even further," says Canter.

To achieve the goal of increasing how many claims were handled per hour from 60 to 80, a simplified entry point was developed along with enhanced validation and business rules which produced a savings of $62,132. Many processes were automated such as replacing manual form letters to auto-generated template letters and the automatic assignment of work, which alone had a system saving of over $32,000.

Training is also much simpler. "It used to take six weeks to train people to work with our software," attests Ed Davis, Director of Support Operations at BCBSAZ. "Now we can get someone up and running in a matter of hours." BCBSAZ reduced training time for new FEC employees by one week and went from two weeks to two days in training new ODC employees. Combined, this reduction in training time has a project benefit of $25,054.

Future
BCBSAZ has gained national recognition from their success on this project thus far. Davis and Canter attribute this to their "unwavering commitment to technology – obstacles will occur but we never give up." The next steps will be to apply the imaging technology to additional business units such as Legal and Human Resources. The OCR technology will also be expanded to apply to additional claim types such as UB-92 claims.

In addition, a workflow solution powered by KnowledgeLake's Pinnacle Workflow Suite Software will be introduced. Pinnacle provides an electronic workflow that moves documents between users. It is HIPPA compliant with a document security feature that produces an electronic audit trail. With the many standard features such as watch, tick, search, notes and route there is room to customize certain features to fit the specific workflow needs as BCBSAZ did. For example, all regional offices are each equipped with their own Kodak 1500 scanner and scan all documents they receive. Not only does this help reduce the volume of incoming mail at the Phoenix office, but it also initiates an automatic workflow process that ultimately speeds the entire business process.

As the projects moves into its next phase many people at BCBSAZ are already thinking how it can expand into other departments and business processes. "The project is a living, breathing organism and you have to treat it as such. It is always dynamic, always changing," proclaims Davis. With the forward thinking of the BCBSAZ team and the expertise of the KnowledgeLake professionals this project will continue to prove its success as BCBSAZ and their customers reap the benefits.

Profile
One of Arizona's largest health care insurers for over 60 years.

Industry
Healthcare Insurance

Application
Claims Processing

Configuration
3 Kodak 9520d scanners
4 Kodak 1500 scanners
1 Kodak 3500 scanner
Datacap Health Claims capture system (HCcs)
FileNET document management system
KnowledgeLake Pinnacle Workflow SuiteM
Hewlett-Packard 1200S optical jukebox
IBM Unix server
KnowledgeLake, Inc.