See how OnCourse helped ValiData with a front-end scrubbing solution.
HCH Administration in Peoria, Illinois is a third-party administrator (TPA) with a problem that’s common to their industry – the quality of the EDI and data from paper claims. Inconsistent data inputs — from claims “mailboxing” for the provider to eligibility issues and data conflicts — dramatically slow down the auto adjudication process. And eat up considerable time and human resources. HCH needed a better system – and OnCourse provided it.
OnCourse provided ValiData, a front end data scrubbing solution. Set up as an ASP, all claims (EDI and data from paper claims) are funneled to the same front end preprocessing software. Robust provider and eligibility matching logic is used to perform automatic selection. CPT, ICD9 and modifiers are all validated using both the standard codes and any unique codes the client has developed. An unlimited number of custom rules known as “quirks” are consistently applied to all claims. The last step is for the operator to make corrections on claims that could not be resolved automatically. This process is designed to quickly and accurately make the final decision, eliminating the tedious process of clearing mailboxes. The data is then output to QicLink for adjudication.
- Provider matches at a significantly higher rate
- Eligibility matches at a significantly higher rate
- Database clean up tools implemented
- Custom claims rules are developed and implemented
- EDI and Data captured from paper claims are directed to the same FTP
- Claims are imported into the ValiData Software
- Automatic tasks are performed
- Manual tasks are completed in a far more efficient process
- Data is output to QicLink for adjudication
- Productivity increases from 100 claims per hour to 300
- Significantly fewer claims are “mailboxed”
- Productivity is greatly improved
- Custom rules, “Quirks”, are universally applied to all claims
- No additional hardware is required to support the software
- Training is minimal
The benefits of invoice approval automation are widely known, however finding an affordable solution that is easy to use, enterprise wide, and can be modified to adhere to your specific business rules and processes can be hard to find. An OnCourse solution checks all of those boxes as well as eliminating the manual capture processes by your team through integration with your ERP.
An OnCourse solution meets you at your point of need; from invoice receipt that allows your vendors to seamlessly continue to submit invoices without change, to indexing the required fields backed by extensive quality control verification from your databases. Using a permissions based approach, access and actions are defined by your rules, not software limitations. Approval routing can be fully automated, ad-hoc direct to approver, or any combination. Escalations can be built in and a detailed audit trail is standard. Let us help you configure a solution that gives immediate visibility to your entire spend.Read Case Study
See how OnCourse helped ValiData with a front-end scrubbing solution.Read Case Study
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