Physicians Medical Group Cuts Processing Time With Datacap Taskmaster

Physicians Medical Group of Santa Cruz County (PMG) cut its claims processing time by more than half and provided faster access to data, fewer compliance concerns, happier employees and more satisfied customers with an integrated solution from Datacap and Bowe Bell & Howell.

Serving an area about 35 miles southwest of Silicon Valley, PMG processes some 250,000 medical claims a year for seven insurance plans and about 300 health care providers. For years, its claims department operated by receiving claims from doctors, hospitals or other providers, manually date-stamping, reviewing and then sending them in bundles to a third-party service bureau. The bureau then scanned the claims, extracted the data and uploaded data and images to a File Transfer Protocol (FTP) site for PMG to access — which could take more than 10 days. Worse, since the electronic data provided by the service bureau regularly contained errors, the claims department first had to wait until the paper claims were returned and verify each one manually. Only then could PMG compensate its providers.

Paying healthcare providers quickly and accurately is PMG's top priority, but with such a labor-intensive process, it often took more than two weeks to settle a claim. That was inconvenient for providers — and costly for PMG. If the company did not reimburse physicians on time, it had to pay interest, so employees frequently worked overtime to meet performance deadlines. When providers were not paid promptly, they sometimes sent duplicate claims, which the claims department had to review again and resend to the scanning bureau.