An EMC Captiva solution is providing digital capture and workflow for rt health fund, a provider of health insurance for workers in the transport and electricity industries for more than 120 years.

One of 37 private health funds in Australia, rt is currently providing services to around 51,000 members. There are close to 60 staff based across three different locations, managing more than 1,300 pages of transactions a day, including hospital, medical and ancillary claims, as well as new membership applications and a wide variety of change requests from current members.

The processing load was up to 2000 claims and applications per week when the decision was made to assess the possibility of moving to a digital platform.

High levels of membership growth between 2008 and 2010 added to pressure on management who were looking to maintain high levels of member service and turnaround times, without adding significantly to the staffing pool.

Tony Delahaye, Manager Information Systems at rt health fund, said the major surge in membership could not have been managed with existing resources, without the paperless solution.

rt has adopted the EMC Captiva platform for capture and processing of paper-based claim form data. Claims that arrive by post, fax or email are captured and automatically classified for processing, reducing the need for manual intervention.

Scanning is accomplished using two Kodak i260 series scanners that had been in limited use by the fund since 2004. ARM arranged for Kodak to extend the warranties due to the low volume of scans on the machines. The scanners are directly integrated to EMC Captiva and no middleware software is required.

The system is currently able to automatically classify around 50% of documents received by the fund, and the aim is to eventually see this figure increase to 100%.

Captiva automatically extracts the membership number from all forms and confirms its validity. In 95% of cases, the header page and invoice are all that is required. For the remaining 5%, any additional supporting documents are classified as attachments.

A new template is only required for major providers, while those that only send in a small volume can utilise a generic template called freeform. Captiva is able to automatically extract machine-printed and hand-printed text from each document.

The solution automatically validates captured data against data sources, business rules and applications. Manual validation is also performed to inspect errors or to enable data correction and maximise data accuracy before delivery to the fund’s P21 core operating  system.

Workflows within P21 then distribute the scanned images  to claims assessors with the relevant screens pre-populated for processing.
CEO Matthew Moore said, “Businesses like ours receive a constant high volume of paperwork that requires manual handling and processing. Anything we can do to make those processes more reliable, consistent, accurate and efficient is vital to delivering excellent service for our members and the healthcare providers we interact with.

“The move to scanning technology has made those business processes more reliable, replicable, consistent and more easily auditable.

“Importantly, the business is also more readily scalable – we have effectively disengaged the growth of the business from the need to match that growth in staff numbers. For a lean, mid-sized organisation such as ours, this has been essential for the management of growth and to enable future expansion.”

rt invested $450,000 for the software, hardware and implementation, with Advanced Records Management chosen as the implementation partner for the project. Completed over a full year in 2010, the rollout was staggered in three phases, occupying 3,200 person-hours and directly involving 20 staff.

For a small organisation, the project involved a major commitment of time and expenditure.

Tony Delahaye said, “We needed to implement the project using many of the same people who were integral to the day-to-day running of the business. We didn’t have the luxury of a dedicated project team that could focus 100% on the implementation, which would have been ideal.”
However, the payoff has been spectacular. In spite of a 40% increase in the volume of hospital claims received in 2010, rt has been able to cope with just a small increase in staff while achieving significantly reduced backlogs.

“We have also observed a reduction in Access Gap claim rejections from Medicare Australia, which has saved us time spent investigating claims. In addition, we have reduced our archiving costs by being able to destroy paperwork after six months, and the fact that we are not distributing paperwork has led to a reduction in postage costs. A secondary benefit has been that we are able to quickly retrieve scanned documents rather than having to recall them from archiving on the odd occasion when we need to investigate an error or dispute.”

Surviving the flood
Customer service gains have been delivered by enabling frontline staff to view the progress of transactions immediately. Yet another benefit arose when the 2011 Brisbane floods affected the fund’s Queensland office. Staff were able to work from home until the office was relocated.
The project was not without its challenges, as moving away from paper workflows presented major change management issues, and required patience from all involved.

“We chose the Captiva platform for our claims workflow because of the additional products and services EMC offers,” said Delahaye.

“EMC provided great support and an excellent project methodology, and it fit all our requirements for corporate governance. They have a lot of health insurance customers in the US which gave them some familiarity with this industry, even though there are significant differences between the health insurance systems in each country.

“The high recognition rates for handwriting have been a bonus, as we have many older members who have been with us for decades, and they prefer to send everything in handwritten. We are looking to increase the level of straight-through processing as we move forward with the project.”
“One of the things that we learned late in the day was that it makes a significant difference to processing speeds if you capture documents laid out landscape instead of portrait.

“As this saves three seconds per page, with our pages at 1,300 pages per day this saved around an hour a day.”