Software From dakota imaging Helps Blue Cross Blue Shield To Process Medicare Claims In 10 States

When BlueCross BlueShield of North Dakota (BCBS-ND) was contracted to process Medicare Part B claims (claims submitted for visits to doctors' offices), the contract covered only North Dakota. The contract had been offered by the Health Care Finance Administration (HCFA), part of the U.S. Department of Health and Human Services. BCBS-ND realized that, in order to grow its business, it would have to obtain a workforce that could work from homes throughout the Midwest. BCBS-ND's managers realized that, to do this, they would need a system that could remotely scan, process, store and manage information. Consequently, four years ago, BCBS-ND entered into a relationship with dakota imaging, a software company based in Columbia, MD, which was founded in 1989.

Before teaming up with dakota imaging, BCBS-ND's operators at its headquarters in Fargo, ND, had to type the information manually on the claim forms into their computers. When dakota imaging installed its Transform™ system (then called groKKer), the process was, quite literally, transformed. Transform is a complete transaction processing software which combines imaging, OCR (optical character recognition) data capture, document storage and management, and remote processing. Since it was installed, the system has been continually expanded to handle additional claims and is currently processing the Medicare Part B claim workload for four states.

How The System Uses Home-Based Operators
By using home-based operators, dakota imaging is helping BCBS-ND enjoy significant savings. "Pay-for-performance" measurement and reporting is built into the Transform system along with automated work distribution and routing capabilities. Remote operators working from home or "Telework Centers" handle OCR data repair, data validation and key entry from image. They accomplish this by using dakota imaging's new Transform Verify for Windows 95/NT software. Transform Verify supports home-based PCs using the Internet, ISDN, dial-up modems and T1/T3 wide area networks.

The system is handling all scanning, OCR processing and optical storage management in Fargo, ND. Only a few data entry operators process claims in the BCBS-ND office in Fargo. These operators perform quality assurance and exception handling only. Most of the claim processing tasks are completed by "Telework Center"-based "telecommuting operators" located in the Midwest, where labor costs are lower. This provides BCBS-ND access to a larger workforce while reducing costs. All BCBS-ND offices in various states are able to search and retrieve document images right from their PCs using the Transform Search software for Windows 95/NT.

BCBS-ND Awarded 10-State Contract By HCFA
In March 1998, the HCFA announced the awarding of a contract to BlueCross BlueShield of North Dakota to process Medicare Part B claims for 10 Western states. The states include North and South Dakota, Alaska, Arizona, Colorado, Hawaii, Nevada, Oregon, Washington and Wyoming. The contract, which entails using more operators working from home, raises the number of claims processed from 10 million to over 36 million per year. BCBS-ND is using the Transform system to perform imaging, OCR-assisted data entry and electronic claim storage management and retrieval using a seamless, one-pass scanning process. Jay Martinson, vice president of BCBS-ND's Government Programs Division, commented on the system. "This process alone has saved us an enormous amount of administrative money, while having a significant positive impact on the quality of entering claim information."