OCR Scanning System Saves Time and Money, Insures Good First Impression.

SOURCE:

Brian Dubiel
Senior Business Analyst
CIGNA HealthCare
900 Cottage Grove Rd.
Hartford, CN 06152
E-mail: Brian. [e-mail]
Phone: [phone]

PROBLEM:

That health insurance card presented at the doctor's office or pharmacy is like a magic key, unlocking significant savings on provider services for the customer. But while the card saves the customer money, it can cost insurance companies plenty.

The card's cost is not just in the plastic, but in the gathering, storing and providing of information to facilitate services wherever the insured person goes. The price tag for processing the information for these cards can run into millions of dollars for insurers.

With more than 12 million people with managed healthcare and indemnity coverage, and 21 million people with dental care and mental health coverage, Philadelphia based CIGNA HealthCare was experiencing a problem all-too-familiar to insurers: How do you provide accurate health insurance cards to new enrollees in a timely manner without spending too much money?

After all, one of the first points of contact between new enrollees and insurance providers comes in the form of that health insurance card. A good first impression is critical to the ongoing relationship. So, we promised to get cards into new enrollees' hands within 10 days. At the same time, that speedy service was racking up big data entry expenses for us. The company wanted to lower the cost of processing the information that lies behind the card, without losing quality.

SOLUTION:

In a perfect world, we could have cut costs significantly just by asking its new corporate clients to use electronic feeds of new enrollment data. But the reality is that handwritten information on paper forms is still the most common delivery method among our corporate clients. We're not going to lose an account over the choice of a form.

Encouraging its corporate clients to use more scanner-friendly onepage, double-sided forms helped lower, the amount of information that had to be manually re-keyed. However, the four-ply carbon-copy forms that are the most expensive to process were still quite common.

To speed up the processing, CIGNA also tried outsourcing the work. But even with the cost-savings of scanning, we were spending 84 cents per form to outsource the function. Sometimes work would be better prioritized based on specific accounts' needs if it were done in-house. We were spending more than we wanted, and we knew we could do it faster.

In October 1997, CIGNA took the suggestion of integrator Imaging Solutions, and developed a scanning system for new enrollment forms that allowed greater volumes of work to be processed in-house. Imaging Solutions recommended Microsystems Technology's OCR for Forms[TM] based on previous successes at other customer sites. The modularity of OCR for Forms was appealing, since we planned to grow the application if the pilot phase proved successful.

CIGNA follows a multi-part verification system to enter new enrollment data onto its Windows NT-based network. Data analysts "scrub" or sanity-check incoming new enrollment forms to make sure no fields are incomplete or incorrect. They then batch forms by account structure, so groups with common account numbers, policy codes and benefit codes can be entered together.

Then analysts bring batches to a Fujitsu scanner and the "identification" process begins by checking the upper left-hand corner of the form so the software will "register" and recognize fields appropriately. Analysts then personally review and verify key fields, such as the policy's effective date and Social Security number, on oversized 21-inch monitors for easy viewing. OCR for Forms assists the analyst in verifying questionable characters.

Once this is completed, data from the form is further reformatted, reviewed one last time for quality, and then uploaded as ASCII text using a CIGNA-developed program. In a parallel process, the images of the eligibility forms, along with a subset of the data collected to serve as indexes, are transferred to OTG for Image Retrieval software for access by many departments including billing, customer service and marketing.

COMPONENTS:

Hardware: One Windows[R] NT server, one Fujitsu 3099 scanner, a Fujitsu 3093 scanner serves as backup; five verification stations; and one scanning station that doubles as a data extraction and form identification station.

Software: OCR for Forms with an add-on AccuZip (address lookup and verification) feature

Networks: Windows NT network

Consultants: Imaging Solutions, Inc. of Wallingford, Conn.

INSTALLATION:

CIGNA HealthCare began a pilot project in October 1997 with a full production system finalized in April 1998.

STAFF, PATIENTS SERVED:

The benefits from this technology accrue to the more than two million new enrollees to our insured base each year. They are guaranteed three-day faster turnaround on the processing of their data and receipt of their insurance cards, with no decrease in accuracy.

BENEFITS:

Savings: CIGNA sliced processing costs in half, cut lead times by one-third and doubled the number of forms that are processed on a daily basis by using OCR for Forms information capture software. All this was achieved while maintaining the corporate accuracy standard of 98 percent.

Patient care: For insurance enrollees, the health insurance card sent by the provider is among the first interactions with the insurance company they've selected. In a sense, the enrollee has put his or her life in the provider's hands, and so this seemingly simple transaction sets the stage for what's to come in the relationship. If a card is late in arriving or contains incorrect information, the provider's credibility and the enrollee's peace of mind is severely shaken.

ACHIEVEMENTS:

Our goal was to get 50 percent of all new enrollment forms for coverage effective April 15, 1999, to be scanned, and we more than achieved it. This application delivers tremendous time- and cost-savings for CIGNA, and it's an excellent way to help establish outstanding customer service from the start.3