Health Insurance Claims Processing
(HFCA-1500, CMS / UB-92, UB-04 / Miscellaneous - Hospital, Medical)

We are one of the largest health insurance claim processing companies in the world. We process 150000 claims a day on peak days. Our state of art infrastructure can scale up this capacity to double at a short notice.

The Claims are processed daily in large volume. The forms printed in non dropout black ink, or hand written claims are scanned and routed to key-from Image Process (KFI) where double blind data entry is performed. The forms printed in red dropout ink, or type written are scanned with red bulb to remove the background & routed to OCR engine. The field content filled up by OCR engine is validated and claim is processed using Reject Repair Process (RR). The documents which cannot be OCR'd with more than 80% accuracy are sent to Key-From Image Process.

The scanned images are sent to the Processing Center in batches where trained operators process these images using set of rules called "Keying Requirements" which are devised after detailed understanding of the client's requirements.

Both processes, i.e. Key-from Image (KFI) & Reject Repair (RR), are highly efficient and accurate. The claims processed by KFI & RR processes are also passed through verification stages. All output is checked through well defined validation tables & exceptional fields are flagged. Such flagged claims are then passed through a flag removing operator.

Experienced auditors perform the final audit of claims processed by operators before submission to client. The output data is submitted to clients in the format specified by the client or sent to Claims Adjudication Department.