Expert Data Management Solutions in the Medical Industry
DocuStream is the premier provider of high-volume transaction processing solutions for the healthcare industry in the United States. With over 25 years of experience, we have established ourselves as leaders in delivering timely and precise processing services with managed care plans to both Payors and Providers.
Our Commitment to Excellence
Since our inception in 1998, we have ensured the seamless processing of healthcare transactions including Claims, Explanation of Benefits (EOBs), Remittance Notices, Prior Authorization Requests, and other documents across EDI formats and paper form types. Our 25 years of expertise guarantees efficiency and accuracy in every transaction.
Discover Our Solutions
Explore our comprehensive suite of services designed to meet your healthcare data processing needs:
1. Medical Claims and EOBs
Efficient handling of Medical Claims and Explanation of Benefits documents.
2. Medicare Remittance Notices
Timely processing of Medicare Remittance Notices to assure compliance.
3. Prior Authorization Requests
Fast turnaround of Prior Authorization Requests to expedite patient care.
4. Real-Time Eligibility Verification
Instant verification services to ensure eligibility for medical coverage.
How We Can Assist You
At DocuStream, we understand the complexities involved in healthcare data processing. From paper-based submissions to electronic data interchange (EDI), our team is equipped to handle it all. Whether you require mailroom processing, EDI verification, or formatting services, we have you covered. For more information, feel free to get in touch.
Leading in Healthcare Data Processing Since 1998
Established in 1998, our journey began with a vision to revolutionize healthcare claims processing through advanced automation technologies. With roots tracing back to the early 1990s, we honed our expertise in large-scale scanning and form processing applications, serving corporate and government entities with precision and reliability.
Pioneering Healthcare Solutions
In the early 2000s, DocuStream shifted its focus to the healthcare industry, recognizing the growing demand for streamlined healthcare data management solutions. Specializing in extracting and processing essential healthcare forms such as HCFA-1500, UB92 (now UB04), EOBs, and MRNs, we embarked on a mission to simplify and optimize claims processing workflows.
Delivering Speed and Accuracy in Claims
At DocuStream, we pride ourselves on delivering unparalleled accuracy and speed while ensuring cost-effectiveness. With a client-centric approach, we have cultivated lasting relationships with insurance companies, health plans, TPAs, and unions. Today, we process nearly two million monthly claims, catering to diverse needs in paper and electronic formats.
Experience the Difference
Partner with DocuStream to elevate your healthcare data processing capabilities. Our commitment to excellence and decades of industry experience position us as your trusted partner in achieving operational excellence and cost savings. Explore our services today to learn more about how DocuStream can empower your organization.
Comprehensive Data Management Solutions
Claims Processing
We process nearly 2 million monthly healthcare claims in our secure San Leandro, CA facility. Our fully integrated workflow includes mailroom & scanning, forms processing & OCR, manual QA and repair, automated validation and external lookups, and custom export data formatting.
DocuStream delivers more than just accurate data. We scrub and verify each field to ensure that the data matches your system's expectations from paper or EDI sources.
This may include provider and eligibility table lookups, internal completeness and consistency checks, custom field padding, and dictionary translations.
Such "pre-adjudication" scrubbing of claim data offloads the busy work from your adjudicators, who can now focus on high-level decisions. Our clients see 30% to 40% productivity gains as a result.
Real-Time Eligibility
Our real-time verification provides immediate responses to inquiries from providers regarding Member Eligibility or Claim Status. Providers get the information they need with one click, reducing the phone calls to your staff.
Our team thoroughly maps your benefit matrix during our real-time verification engine implementation. Responses are returned to the federally mandated X12 format for compatibility with most provider systems.
The ability to respond immediately to Provider requests not only saves time and money for your organization but also ensures HIPAA and ACA compliance under the CAQH CORE rules.
EDI Data Formatting
We have worked extensively with custom and legacy data formats, helping clients transition to the latest HIPAA-mandated EDI file formats.
For example, we can help you implement the 837 5010 claim, 277 status response, and 835 remittance advice formats. These standards are required, and CMS is imposing fines on non-compliant Payors. Updating current EDI standards will also dramatically cut costs and improve productivity.
Prior Authorization Requests
DocuStream can process your Prior Auth Requests in a fraction of the time and cost, eliminating backlogs and freeing your staff to focus on high-level decisions.
We take in the faxed requests sent by Providers and extract the relevant data. We then scrub and verify the data for member eligibility, provider network, and other key fields.
Providers get a quick return fax, acknowledging receipt and informing them of any data fields that fail our validations. This dramatically improves Provider satisfaction and reduces phone calls, duplicates, resubmissions, and inappropriate use of the Urgent checkbox. Read our Case Study here.
Our standard turnaround is 12 to 24 hours for Urgent and one business day for Routine. We can also deliver a recommended adjudication of the PA Request based on our analysis of the data and the doctor's notes.
OCR Data Capture
DocuStream has been at the forefront of Optical Character Recognition for document data capture since the mid-1990s. We work closely with leading OCR vendors, such as top-rated Prime Recognition.
We combine Prime's multi-engine voting OCR with automated image enhancement and dynamic zoning that locates specific data fields even when the form layout has changed.
But OCR is only one step in the process. Operators and automated processes verify and correct the data before formatting it to your system's specifications. The resulting data file is as accurate and complete as possible.
Mailroom Processing/Scanning
If you want to eliminate paper, we offer full-service mailroom processing that includes envelope opening, paper unfolding and staple removal, sorting, scanning, date/time imprinting, secure storage, and secure shredding.
We convert the incoming paper to indexed images that you can instantly access either in your document management system or using our ScanNStore imaging storage and retrieval software.
Products
ScanNStore
ScanNStore is a full-featured electronic document storage and retrieval system in a small package. It's the perfect solution for increasing productivity by electronically organizing and managing paper files.
ScanNStore lets you and your staff quickly scan, index, store, and retrieve your claims, attachments, remittance notices, and other documents. You can search by multiple indexes and display claims and all related information on-screen as if looking at the original paper.
Where instant access to the right claim information is critical, ScanNStore is the right solution. Contact us to download and try out a fully functional multi-user version of ScanNStore for 30 days. Volume seat licensing and vendor discounts are available.
Scanners: Supports various TWAIN and production-level scanners, including HP, Fujitsu, Ricoh, Bell & Howell, and Panasonic. It supports single-page or multipage batch scanning, an automated document feeder, page size, contrast adjustment, and scan intensity.
Databases: Supports widely used industry-standard Microsoft Access databases and SQL Server using ODBC. Keywords or descriptive information can easily be exported from Access Databases created with Scan 'N Store into spreadsheets or other reports, or exported to create new databases. Images and keywords are stored in separate databases.
Indexing: Create an unlimited number of index fields. Use Hot Keys for fast indexing, image viewing and manipulation while indexing. Easily add or delete fields, even after adding images to the database.
Viewing: Display B&W or color images in major formats, including TIFF, JPEG, BMP, and GIF. Fast Multi-page viewing includes fast "go to" pages and next, previous, first, and last. Special magnifiers let you zoom in on specific parts of an image.
CalAIM CS / ECM claims
California's Department of Health Care Services (DHCS) is expanding Medi-Cal to cover clinical-adjacent services, called Community Supports (CS) and Enhanced Care Management (ECM) under the CalAIM program.
Community-Based Organizations (CBOs) who deliver such services can bill local Managed Care Plans (MCPs) under CalAIM. However, most CBOs lack the practice management systems needed to generate and transmit HIPAA-compliant EDI claims to the MCPs for payment, leading to frustration and non-compliance with HIPAA rules.
DocuStream connects CBOs and MCPs to carry out electronic HIPAA-compliant claims transactions, reducing frustration and enabling more CBOs to participate and get paid. We also ensure that two-way claims transactions are HIPAA-compliant for both CBOs and MCPs.
If you are a CBO looking to bill for your CS / ECM services, or if you're an MCP looking to transact claims data in a HIPAA-compliant manner, DocuStream can help. Give us a call!
You can find instructions for filling out a claim sheet here.
DocuHealthLink
DocuHealthLink is a small program that runs on your PC alongside your existing billing software. To make electronic copies of your claims, print them to DocuHealthLink precisely as you print them to paper now—that's all there is to it!
Then, with the click of a mouse, your claims are transferred electronically to us for processing, and then forwarded to your Payors. You will get immediate confirmation that we have received your claims, and the next day you will get a report of the claim status and any rejections.
Best of all, you don't need to change anything; keep your existing PC and billing system, and keep your current processes in place. There is no need to spend money and retrain on a new system. Just stop folding paper and licking envelopes!
Clients
Community Health Plans
Our Community Health Plan clients have seen a large influx of new members and increased claim volume under the ACA, straining the claims' adjudication process. DocuStream reduces claim and Before Auth backlogs and speeds up adjudication by scrubbing and formatting incoming data to validate correctly against the health plan's databases. This greatly reduces the work required to approve or deny claims and auth requests.
Commercial Insurers
DocuStream provides high-volume claims processing services to a wide array of healthcare payors. Our services include high-speed scanning, intelligent form recognition, and zoning, high-accuracy OCR data capture, manual correction, rule-based validation, provider & eligibility scrubbing, EDI file formatting, and Coordination of Benefits processing.
Because we combine state-of-the-art automation with diligent manual quality control, we can process our clients' claims from paper and electronic sources with fast turnaround times and extremely high accuracy.
TPAs & Unions
We work closely with TPAs and union plans to meet their unique requirements. If processing needs to be done in the US with American labor, DocuStream will do it at a fair price. And because of the efficiency of our workflow operations, that price will probably be lower than expected. Give us a call today to find out how DocuStream can meet your US claims processing needs.
Clinics & Physician Offices
Clinics, hospitals, and physician offices can now send their remaining paper claims electronically from their existing billing systems via our DocuHealthLink service. This eliminates the remaining paper and provides immediate notification of claim submission and rejects status, reducing phone calls and duplicate resubmissions.
Community Health Plan
One of DocuStream's longstanding clients is a Medi-Cal Community Health Plan that has seen a large influx of new members since the ACA and Medi-Cal expansion. This caused a spike in claims and Prior to Auth requests, many of which are still arriving via paper and fax.
DocuStream had always provided mailroom letter opening in addition to our regular scanning and data capture services, but this situation required a new approach.
For this customer, DocuStream is using DocuHealthLink to transform a portion of the paper claim flow into an electronic process – without changing any systems or processes on either the provider or the payor side. You can also read the Prior Auth processing case study here.
Coordination of Benefits
Coordination of Benefits has always been a complex adjudication problem. And when such claims must be processed on paper, the workload for the claims staff increases dramatically.
DocuStream developed a semi-automated, high-volume processing service that matches each data record from the CMS-1500 or UB04 claim with the corresponding record from the Explanation of Benefits or Medicare Remittance Notice.
The result is a very accurate matched record that is scrubbed, validated, and pre-adjudicated before upload into the payor's system. Now the claims staff can focus on the high-level decisions, dramatically increasing their productivity.
Our Healthcare Cases and Growth Challenges
At DocuStream, we revolutionized utilization management processes for Pacific Community Health, addressing challenges stemming from rapid growth and regulatory demands. We transformed healthcare claims workflows through strategic collaboration, eliminating delays, and driving cost efficiencies.
Addressing Growth Challenges
From 2014 to 2016, managed care organizations across California experienced a surge in membership, largely attributed to the implementation of the Affordable Care Act (ACA). Pacific Community Health, an amalgamation representing two of our clients, encountered remarkable growth rates exceeding 30% annually. However, this expansion posed significant challenges as operational costs soared and existing staff struggled with document management programs. Thereafter, escalating workload while adhering to stringent regulatory standards.
Get in Touch
Are you ready to streamline your healthcare data processing and drive operational excellence? Connect with us today to learn how DocuStream can tailor solutions to meet your organization's unique needs. Whether you're facing challenges with claims processing, prior authorization requests, or workflow management, our team is here to help.
