CEC (Community Eye Care) administers vision benefits for employers associations and health plans. Among the 150,000 HCFA 1500 forms it processes every year, 56,000 are paper. Processing the paper forms required tedious and error-prone manual input — until ABBYY FlexiCapture provided fast, accurate and automated form capture.
"We’ve seen nothing but great results from FlexiCapture. We have been able to decrease costs because our system is so effective," said Amy Eatmon, COO/Director of IT, Community Eye Care.
CEC was founded in 1998 by Drs. Marvin Schrum, O.D. and Stephen Pollock, MD with one idea in mind: offer vision plans that simplify routine eye care. As providers themselves, they recognized the need for an uncomplicated vision plan that was both easy to administer and easy to use. This, and a dedication to quality service, has seen CEC’s client portfolio expand to a variety of employer groups including hospitals, financial institutions, local governments and school systems.
CEC’s exceptional product and outstanding service have translated into accelerated growth, with additional expansion anticipated. But while most claims are submitted online, one-third are paper HCFA 1500 forms received via fax and mail. Capturing this data required manual entry into the company’s proprietary member eligibility and claims management system, known in-house as SPECS.
“Last year alone,” says Amy Eatmon, CEC’s COO and Director of IT, “we processed 56,000 HCFA 1500 forms manually. Hand-keying this data into SPECS took the efforts of four people, and was inefficient and prone to errors. With the projected growth we foresaw, we would have to add at least two more claims processors — ultimately increasing costs and potentially impacting our product pricing. Implementing an automated form capture became the obvious answer.”
In their search for a solution, Eatmon’s team reviewed a wide range of options but concluded none were suitable for CEC’s unique needs. “An off-the-shelf product wasn’t going to work,” Eatmon says. “We needed to create a highly-customized solution and finally ran across ScanStore — an ABBYY partner who had deep experience in automating HCA 1500 form capture. They recommended ABBYY FlexiCapture and after an extensive demo we knew it would give us the power to achieve our goals.”
With ScanStore’s assistance, CEC began tailoring FlexiCapture to meet its unique demands. “We prefer to develop our solutions in-house, and ScanStore was a fantastic partner to work with,” explains Eatmon. “The software’s flexibility was key to helping us meet challenges arising from our need for extensive customization.”
As an example, the large amount of data on HCFA 1500 sheets required use of color dropout for optimal recognition accuracy. “This was an important requirement,” explains Cheryl Salemy, National Sales Director, ScanStore. “Dropout forms have a color background with white rectangles serving as character cells, checkmark fields, etc. This is great for recognition, but makes verification difficult. So CEC’s team took advantage of FlexiCapture’s ability to use an Image Overlay in the verification screen — meaning the form background is shown along with recognized data, making verification easier.”
According to Eatmon, CEC’s FlexiCapture-based solution was completed to plan and was integrated with the company’s SPECS system. Two members of the claims team scan claims into FlexiCapture and perform verification within the software. The data is then transferred into SPECS via SQL job and SQL stored procedures. Additional validation logic is run against the claims data and further exceptions are identified and corrected within SPECS.
“The initial results have exceeded our expectations,” Eatmon says. “And we continually fine-tune FlexiCapture to get even better. Today our accuracy is outstanding and 80% of the claims go through the system electronically. Verifying the rest is a breeze in FlexiCapture.”
“Overall,” says Eatmon, “we’re ecstatic with the outcome because the system has worked even better than the business case that was originally presented. Our claims department is much more efficient and our projected costs have decreased.”
Plus, as Eatmon describes, FlexiCapture is not only benefiting CEC, but its customers, too: “We’re able to keep our prices down, simply because we’ve become so much more efficient. The software has increased our productivity as well as employee satisfaction and has eliminated the need to bring on additional staff. And ScanStore has been a fantastic partner. They’re always available for questions and support and if an issue comes up they work with us until it’s resolved.
“We’ve seen nothing but great results,” Eatmon concludes. “I’m so glad we moved forward with the project and am interested to explore other ways that ABBYY can help us in the future.”