The document discusses the challenges facing medical claims processing, including the large number of paper claims submitted each year and anticipated increase due to the Affordable Care Act. It notes that billions are spent on mispayments and interacting with health plans to correct errors. The Kofax Medical Claims Automation Solution aims to address these challenges by automating the extraction of data from paper and electronic claims, classifying them, validating the data, and exporting it in standard formats. It is designed to work with both old and new medical coding systems and claims forms to improve efficiency and reduce costs.

1. Kofax Medical Claims Automation Solution
The Challenges Facing Medical Claim Processing
1.2 Billion
paper claims submitted
and processed in 2012.
Up to 45 Million newly insured
anticipated from implementation
of the Affordable Care Act.
$6 Billion
of claims are
mispayments.
Export Connector
HIPAA Compliant EDI Export
Automatically populate claims
adjudication systems with 837P
standard 5010 EDI compliant
export files that are created with
validated data that is automatically
extracted from paper and
electronic medical claims forms.
The new ICD databases expand from
around 15,000 codes with the ICD-9
code set to more than 160,000 codes
with ICD-10, representing a 10X increase
in codes.
The platform is pre-configured for the new
and old forms and the new and old ICD
codes. It is a scalable, enabling capture from
centralized operations as well as directly from
the Point of Origination.
The AMA estimates $2.36 of waste
per claim for electronic claims and
$6.63 per paper/manual claim.
$31 Billion, or $68,274 cost on
average per physician, per year to
interact with health insurance plans to
correct errors and dispute denials.
$31 B
$68K
$6.63
$2.36
Lower paper claim
processing costs
Improve customer service
and satisfaction
Increase productivity and
reduce costs
Increase transparency and
HIPAA compliance
Reduce Costs
Across the Enterprise
Improve
Top Line Results
The Kofax Solution Business Value
Kofax Medical Claims Automation Solution
Allianz Slovenska
Processing time reduced from
up to 4 days to just minutes;
output increased
Real World Results
Pan-American Life
Insurance Company
Number of claims processors
dropped from 50 to 20
Kofax Optimized Medical Claims Processing
Automation
Extraction
Classification
Validation
Export
Replaces existing
systems that are too
expensive to upgrade
Lowers the cost to
in-source claims
processing
Improves productivity
and compliance with
existing manual claims
operations
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