Claims Processing System No Longer Feels Like a Painful Root Canal

THE BACKGROUND

Dentegra Group, Inc., part of the Delta Dental Network, one of the country’s largest dental benefits delivery systems, serves enrollees in both commercial and government-sponsored programs. Dentegra initially only utilized OPEX® Model 72™ Rapid Extraction Desks to open envelopes. Once the envelopes were opened, the contents of the envelopes were manually sorted before the tens of thousands of claims were processed on separate document scanners.

THE CHALLENGE

Manually sorting and processing claims involves multiple steps for sequencing, verifying, and adding barcode labels. Scanning smaller documents means taping them onto carrier sheets and inserting separator sheets to define transaction breaks. High-resolution film X-rays were handled by a separate scanning process which caused high labor costs and sacrificed speed. While the opening, sorting, and scanning operation was reliable, Dentegra knew that automation could help reduce labor and accelerate claim processing. The organization needed additional intelligence in its systems to accomplish that automation.

THE SOLUTION

OPEX and Mavro introduced Dentegra to a one-touch scanning solution utilizing nine OPEX integrated Model 72™ envelope extraction desks, Falcon® scanners and MavBridge™ software for claims processing. A single operator can pull documents from the opened envelope with no manual sorting. They are scanned in any sequence, regardless of size. The electronic images are handed off to MavBridge software where they are classified, electronically sorted based on Dentegra’s business rules, and then sent on to the next step in the claims adjudication process.

In addition to the paper handling efficiencies delivered by OPEX, the virtual batching functionality in the Mavro solution is key to the success of this process. Every document is classified into a category based on its content, and then MavBridge automatically sorts each image into the correct sub-batch. Once those sub-batches are created, the Mavro system sends the documents to the correct downstream process as if they had been physically sorted prior to scanning.

THE FUTURE

With the success of the joint OPEX/Mavro solution, Dentegra is exploring other areas of their business that will benefit from its efficiencies, such as the processing of their remittance payments.