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Kofax Solution Enables Leading Portuguese Government Finance Organisation to Process More Than 2 Thousand Claims Documents Daily and Reduce Costs Situation

Assistência na Doença dos Servidores do Estado (ADSE) is an entity of the Portuguese Ministry of Finance. ADSE is responsible for the financing and reimbursement of healthcare services for approximately 1.3 million federal government employees. ADSE combines government funding and revenue generated from insurance premiums to reimburse invoices received from more than 2,800 private and public healthcare providers and more than 5000 pharmacies and also provides direct payments to its beneficiaries.

Challenge

On an annual basis, ADSE typically receives more than 2.4 million healthcare benefit claims forms and related documents from domestic and international healthcare providers and pharmacies, each of which is processed at its headquarters in the city of Lisbon. Due to the large volume and complexity of claims forms and wide disparity of document types, ADSE devoted 273 of its employees to manually enter claim data into its proprietary reimbursement system, a process which consumed a great deal of time and labor. ADSE employees would typically process a maximum of approximately 300 claims forms on any given day and considered the process to be tedious, time consuming and labor intensive. According to Dr. Luis Pires, Managing Director at ADSE, the typical time required to process a claim from receipt to reimbursement was between two and three months. “Our employees were spending a tremendous amount of time manually processing claims, which both reduced employee morale and productivity while increasing our internal costs and overhead,”said Pires. “Due to our lack of an efficient document management system, ADSE was facing a large backlog of claims – sometimes a month or more. Naturally, this negatively impacted the relationships we have with our customers and our ability to process claim reimbursements in an efficient and timely manner.”

Solution

ADSE thoroughly investigated how to improve its reimbursement process and capture claims documents efficiently and accurately. ADSE turned to Documatica, a local software and systems integration firm and Kofax Certified Solution Provider, to implement a Kofax document capture system. The solution included Kofax Capture, the world’s leading information capture platform, and Kofax VirtualReScan (VRS), the de facto standard for capture productivity and quality throughout a document’s life cycle. “We needed to create an automated system which would drastically improve our efficiency in processing claims and be robust enough to capture complex, multi-page claim forms in a variety of sizes and formats,” said Pires. “We felt Kofax provided the best capture technology for our needs and served as an ideal foundation for the new document management system.” Following implementation, all claims documents now arrive at the central ADSE office and are scanned using VRS and Kofax Capture. A variety of claims data is captured, validated and extracted from each document, including beneficiary identifiers, receipt numbers, dates and dollar value, which are then released into the ADSE central repository. Once validated and approved, each document is processed for payment.

Results

The Kofax solution has significantly improved ADSE’s ability to serve its customers in a fast, reliable and efficient manner. A single employee is now able to process more than 2,000 documents daily and access all relevant claims data quickly. ADSE can complete claims reimbursements in five to eight days, as opposed to its prior two to three month turnaround timeframe. Additionally, ADSE was able to reduce the amount of employees devoted to claims processing tasks from 273 to 235 employees, resulting in a huge cost savings.

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