Baptist Health is South Florida's largest not-for-profit health care organization, encompassing seven major medical facilities and a number of outpatient centers. They utilize a health information system provided by Siemens called INVISION, and a claims management system from NDC Health called ePREMIS.
Effective claims processing and management is the name of the game in the world of hospital finances and administration. Hospital systems that process claims accurately and efficiently are usually financially healthy whereas those that don't typically experience cash crunches. For Baptist Health, this fact is complicated by the size and number of facilities that generate claims. Each medical facility generates 837 inpatient and outpatient claim files, but ePREMIS will only accept one inpatient and one outpatient claim file each day. Consequently, the IT department at Baptist Health needed a way to join an array of 837 claim files into one file and import this file into ePREMIS.
In the past, the Patient Financial Services (PFS) department at Baptist Health processed claims the old-fashioned way—with a litany of very laborious, repetitive, and manual activities. Not only was this process time-consuming and costly, but errors and delays were introduced with all the manual work. For example, when the number of claims processed did not match the summary report (called the BILLSUMC report) PFS personnel had to spend a lot of time researching to determine which claims were overlooked or unprocessed.
Baptist Health realized that this approach was completely inadequate, so a team was created to take a fresh look at the process with the goal of streamlining and automating as much as possible. The team's goal was to streamline the claims management process and included some specific objectives. The first was to automate the daily downloads of 837 claim files from a Siemens server located in Philadelphia, and import the data contained in these files into the ePREMIS application. Next, the team wanted to sunset older code. In the words of Jason Stoyles, the team's supervisor, "We didn't want simply to replace old code with new code; we wanted a new solution." Finally, the team wanted to create an automatic audit process to assist the PFS personnel in identifying missing claims.
The team at Baptist Health turned to Automate's business process automation software to help streamline the cumbersome, manual process of claims processing. The first step in the process was to automate the daily transfers of the individual 837 claims files (both inpatient and outpatient) to an FTP server. When the files are detected on the FTP server, an Automate task is initiated that joins all the inpatient files together and all the outpatient files together. Once this is completed, the two files are transferred securely to the ePREMIS application via FTP.
To automate the process of auditing to ensure no claims are overlooked, the team uses Automate to parse through the 837 files and extract claim identifiers and other critical information. The total number of claims is then compared with a total number extracted from a summary report called the BILLSUMC report. In the event that the number of claims processed does not match the expected total, an audit report is generated for PFS personnel. The PFS workers then import the serialized claims into an Excel spreadsheet that they methodically review to identify unprocessed claims.
In all, the team's Automate processes took a year to develop, test and perfect. Now, over 40 different Automate tasks are in production. This results in greater centralized control over the thousands of file transfers that occur each day, and greater consistency with data and timeliness.
In addition to greater process control and dependability, the employees at Baptist Health are saving a lot of time with their Automate solution. According to Jason Stoyles, "Automate is a huge time saver. The clients on the other end of our 837 processes have stated it is saving them approximately 10 hours a week in manual work. And, I am saving around 5 to 10 hours a week centralizing our FTP and file transfer processes with Automate and using its email capabilities for auditing and notifications. I want to use Automate to solve more issues, and I already have 18 new tasks in development."
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