Overcoming the Common Challenges of Processing Medical Claims

Thursday, June 9, 2022 | By Stephanie Neveu, Product Manager

Overcoming the Common Challenges of Processing Medical Claims

The CMS 1500 Form, also known as the HCFA form, is an industry-standard form used for medical claims. It is federally regulated and required by Medicare. The general assumption for the CMS 1500 form is that it’s standardized—one form is used by everyone. But in reality, there’s no strict mandate to eliminate the use of older versions. Because of this, many providers continue to utilize older versions of the forms for convenience, each of which has 250+ data fields.

The electronic alternative of the form isn’t common because of the complex software requirements, causing claims to remain mainly paper-based.

Aside from its numerous versions and high volume of printed text, some of the most common challenges with the CMS 1500 form include:

  • Poor quality images of the form: This occurs when the CMS 1500 form is scanned, faxed, or has illegible handwriting (and sometimes all of these).
  • Misaligned data on the form: Old scanners and faxes used by healthcare providers produce low-quality scans, including printed and handwritten information, often at an incorrect angle and offset.
  • High error rates: The high volume of manual data entry is labor-intensive and prone to human error.
  • Difficulty digitizing the form: CMS 1500 forms are mostly typed, with vertical lines that confuse traditional OCR, and printer misalignments that cause the text to not always fall in “white spaces.”

Examples of different versions of CMS Form 1500

Many insurance providers aren’t able to keep up with these challenges on their own, but luckily, there is a solution. Enter Intelligent Document Processing (IDP). IDP, like Chorus Document Automation, intelligently extracts, prioritizes and contextualizes forms 1000x faster than humans, reducing manual staff effort and increasing accuracy. IDP identifies the form as an HCFA form and the correct version and is able to extract data directly from the form.

​Adopting IDP to sort and classify the multiple variations of the CMS 1500 form leads to greater accuracy and less time spent manually correcting errors. Higher accuracy in digitization provides less human review and downstream corrections, resulting in a dramatic reduction of see-and-key labor, a drastic improvement in straight-through processing and better turnaround time.

We unpacked the challenges clients have faced with the CMS 1500 form, along with how to digitize the form in our "Conquering the CMS 1500 Form with Intelligent Document Processing" webinar. Watch the replay to learn more about the benefits of intelligent document processing.

Healthcare, Insurance

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