Claims Management Software Smoothes Workflow, Saves Money

"Our system manages all that information and collects it into an electronic file that the carrier can use for payments, reporting and customer service," Sarich says.

The typical FileNET system runs in a client server environment and often handles 5,000 to 6,000 users, the company says.

"Weve seen productivity increases in the 200% range in some cases, with an ROI in 18 months or less for total system costs," says Sarich. "In terms of overpayments eliminated, companies have saved 10 times what the system costs."

That cost can vary widely, depending on how many users an insurer has, but typically runs from $1 million to $5 million, Sarich says. The system may take 10 months or more to implement.

Captiva Software Corporation, San Diego, works with other vendors, including FileNET, which use its optical character recognition system and other information-capture technology to help their clients manage information.

Captivas ClaimPack software allows insurers claim-handling personnel to use scanners to capture claim information from various documents, then automatically enters the data into the insurers claims-processing system, says Captiva spokesman Rob Jensen. The system can also scan faxed documents and incorporate information handled by company call centers or other sources.

Jensen says the system is able to handle the vast majority of claims automatically, without human intervention.

Once adopting this system, an insurer can typically redeploy half of its claims-handling force, and the return on investment for the companys software is often "under a year," he adds.

Jensen declined to cite the cost of the system, noting that Captiva charges a licensing fee that varies according to number of forms, volume, computer system and how much training the user needs.

TriZetto Inc., Newport Beach, Calif., notes in a recent press release that over $1.2 trillion is spent on health care in the United States each year, and an estimated $55 billion to $65 billion of that is spent on administrative information technology.

TriZetto licenses software or serves as application service provider for more than 500 health insurance industry customers with more than 90 million enrollees, the company says.

TriZettos application service provider unit for claims management hosts applications from more than 40 vendors for a monthly fee.

Company spokeswoman Audrey Mautner says TriZettos Facets software is used by more than 50 health plans, including a third of the nations BlueCross BlueShield companies.

Although she declined to be specific on price, she noted terms are based on many variables, including whether TriZetto hosts or licenses the software to the customer, the size of the customer, and how many individuals are served on the software.

HealthWare, Trizettos software engineering unit, develops and licenses applications for payers and benefits administrators, she notes.

One customer, BlueCross BlueShield of Tennessee in Chattanooga, achieved $5 million in annual savings from efficiencies realized by its Facet system, Mautner reports.

TriZetto says its HealthWeb product allows health plans to exchange information and conduct business over the Internet with members, providers employer and brokers.

Reproduced from National Underwriter Life & Health/Financial Services Edition, November 4, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.