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Employee Benefit Management Services is an innovative benefit
administration and management company dedicated to providing superior
quality and cost-effective personalized service. Utilizing both
local and remote KODAK scanners, they process thousands of HCFA-1500,
and UB-92 insurance claim forms per day. In addition to paper claims,
EBMS processes EDI transactions.
ELA form processing was installed at EBMS in July, 2002, and integrated
with their imaging and adjudication systems. The scanning functions
were transferred to ELA in order to provide an electronic document
ID to each claim. The data capture system solution was implemented
and integrated within six weeks from date of contract.
In addition to the scanned paper claims, EDI data streams are
received and processed through the ELA EDI module. Both HCFA and
UB claims data are accepted in the ANSI 837 file format. The EDI
files are sent via FTP to the ELA EDI module that generates synthetic
images of the claim forms. The synthetic images are placed into
the validation workflow to allow consistent business rules to be
applied to both paper and electronic claims. The synthetic images
are also exported to the imaging system for adjudication and customer
support.
Databases are used to enhance recognition as well as for validation
of the claims. This minimizes front-end human interaction and maximizes
the quality of the uploaded claims data. The EBMS data entry
staff is processing an average of 1000 claims per day per operator.
Employee Benefit Management Services uses the ELA form processing
system to generate synthetic images of both HCFA and UB claim forms.
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