Podiatry Plan has improved the lives of hundreds of thousands of people through their comprehensive approach to managed foot care. But an urgent need to meet a new requirement for EDI form submission meant having to implement a solution for digitizing CMS-1500 forms fast – a challenge that was easily met with ABBYY FlexiCapture.
Podiatry Plan was established to meet the requirements of Labor-Employer Trust Funds (ERISA) regarding the delivery of Podiatric Medicine to their beneficiaries. And since its inception in 1982, the organization has grown to include a wide range of clients. “Our approach is guided by a commitment to saving our clients money, while improving the quality of their beneficiaries’ lives,” says Annie Scherer, Office Manager, Podiatry Plan.
Such commitment to excellence translated into a fast-growing client list, including other trust funds and healthcare companies. And in 2009, a major Medicare Health Plan joined Podiatry Plan’s clientele – bringing new beneficiaries, service needs and compliance requirements.
“The Medicare Health Plan,” explains Scherer, “came to us with the need to provide routine foot care for their beneficiaries – which Medicare does not offer and is really important for seniors.”
Podiatry Plan ensures that the Medicare Health Plan’s patients get care from within their network of podiatrists, then processes the claims and, uniquely, pays the claims. “We just price and process claims for the other trust funds and insurance plans,” says Scherer. “For this client, we also do the payments – and since they’re a Medicare Advantage Plan, the Centers for Medicare and Medicaid Services (CMS) require a CMS-1500 form to be submitted for each claim.”
And according to Scherer, CMS rules regarding claims submissions, credentialing, utilization and financials have grown more complicated every year. “Our program for our client expanded steadily, as did our CMS-related tasks. And we evolved to handle the extra administrative work.” But in 2012, new requirements for submitting claims using Electronic Data Interchange (EDI) were instituted by the client. And Scherer’s team had to move fast to meet them.
“Essentially,” says Scherer, we were told that CMS-1500 claim forms would need to be submitted via EDI instead of fax – and that only two months were available to make the transition.” And with hundreds of paper CMS-1500 forms arriving every month, manually entering data from each into a digital format was not an option – making it critical to automate the capture and conversion of forms.
So with just eight weeks to find a solution, Podiatry Plan fast-tracked the project and found their answer in ABBYY FlexiCapture.
On the recommendation of their IT consultant, Podiatry Plan contacted WiseTREND, led by Ilya Evdokimov, who recommended a solution based on ABBYY FlexiCapture. “The software is powerful, yet remarkably flexible when it comes to implementing new rules and automation tasks,” Evdokimov says. “This makes it easy to customize FlexiCapture for the extraction, conversion and validation of data from documents and forms, including CMS-1500. The resulting solutions are user-friendly, very robust and provide a high degree of accuracy and consistency.”
According to Scherer, implementation was fast: “It took just two weeks, from our first conversation with WiseTREND to processing claims,” recalls Scherer. “Ilya did an amazing job.”
And as Podiatry Plan’s Claims Adjuster says, learning to use the new FlexiCapture-based solution took very little time and was very easy: “The learning curve was short,” she recalls. “In fact, ramping up to full competency was near-immediate. It was easy from the beginning and anything that came up afterwards was solved with a quick phone call to WiseTREND.”
Today, Podiatry Plan processes claims for a very large number of the Medicare Healthcare Plan’s beneficiaries and receives several hundred claims every month. Paper CMS-1500 claim forms are captured using a Kodak desktop scanner and processed by FlexiCapture. The software then performs rules-based validation and the operator performs a final check. The data is then automatically exported as a file and batch-imported to the FileMaker Pro database and from there sent to CMS.
Scherer also points out that Podiatry Plan anticipates that their work will continue growing at a fast pace – something that Evdokimov asserts will be no problem using the current solution: “Since implementation three years ago, the system has been able to handle an ongoing increase in document volume with no modification. And if Podiatry Plan finds that it suddenly needs to scan an extra 1000 forms a day, the same system would definitely handle it without need for change. That’s one of the benefits of going with a solution based on ABBYY FlexiCapture.”