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ABBYY Turns Medicare Mess into Usable Compliance Data

Mike Stuhley

September 15, 2023

For millions of Americans with Medicare, there can be one, two, or even three insurance companies involved with medical bills. When there is more than one payer, “coordination of benefits” rules decides who pays first. Imagine the mess of bills, letters, and other documents that need to be processed to ensure compliance with Medicare rules.

Fortunately, ABBYY provides IDP (intelligent document processing) technologies that can automatically classify documents and extract required fields. The extracted fields can be fed into the claims system to ensure compliance with Medicare rules.

As an example, there can be more than 50 types of Medicare claim letters. As the first step in automating the document process, ABBYY’s IDP solution can automatically classify the letters into “Conditional Payment,” “Final Demand,” and other letter types—all without any human intervention.

For every Medicare claim letter, dozens of important fields need to be extracted including beneficiary name, Medicare number, and policy number. Each letter has a different format, with the key fields in different places and even different pages. ABBYY IDP automatically extracts the required fields without any manual data entry and feeds those fields into the claims system.

Where the fun really starts is where some Medicare claim letters have the required data embedded in paragraphs, but the claims' system only needs the underlined fields.

We have received check number 0012180604 in the amount of $752.36. This amount has been applied to the outstanding debt. The remainder of the debt must be repaid. The outstanding debt is principal $9,911.52, interest of $0.00 and a total amount due of $9,911.52.

Example of paragraph within Medicare claim letter

ABBYY’s IDP technology can process the unstructured paragraph above into usable fields that fit into the database rows and columns required by the claims processing system and can even format the fields to remove any characters (like dollar signs) that are not required by the claims software. The magic of ABBYY’s solution is that all of this happens automatically, without any human intervention.

ABBYY ensures quality by providing multiple data integrity checks for every field. For example, in the paragraph above, the solution verifies that the check number only contains numeric characters. If the extracted check number contained an alpha character, the platform would produce an error code so that bad data is not inserted into the claims processing system.

While this automated processing sounds difficult to set up and maintain, it isn’t. Fortunately, ABBYY takes out all the complexity with a “no code” platform. This means that anyone who can use a spreadsheet can use ABBYY’s IDP solution. For example, if you need to add principal and interest to get the total, you just point and click on the fields. No writing of any computer code is required. All of the document and field properties are controlled by pointing and clicking on configuration options.

Speed, compliance, and accuracy in healthcare document processing is important to every one of the millions of Americans with Medicare. Fortunately, ABBYY IDP makes it possible to automatically process the mountain of healthcare documents generated every day and get usable data into claims processing systems.

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Mike Stuhley

President at Formtran, Inc.

Mike Stuhley has 30+ years of experience in the document and business process automation industries. He has held executive positions with industry leading vendors including Scantron and Cardiff Software. Stuhley has been a frequent speaker at industry trade shows including AIIM, ARMA and BFMA. He is also a co-author on a patent for classifying documents. He holds a bachelor’s degree in Finance from San Diego State University.

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