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.

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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.

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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.

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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.