Case Study: Health Choice Arizona

 

Health Choice Arizona turned to InStream for help in processing faxed, handwritten prior authorization (PA) requests. InStream responded with data entry services and FileBound workflow implementation. The result? Health Choice Arizona saved hundreds of thousands of dollars in labor costs, achieved quicker, more accurate PA processing, and greater overall satisfaction for their members.

It’s About Your Health

Health Choice Arizona is a managed care organization that provides healthcare to 195,000 people in Arizona’s Medicaid Program, the Arizona Health Care Cost Containment System (AHCCCS).

InStream Results

• Saved approximately $600,000 in annual labor costs
• Eliminated paper and toner costs for 40,000 to 200,000 pages per month
• Reduced PA data entry time from days to 12 hours with significantly fewer errors
• Eliminated delays and costs required to access files in offsite storage
• Increased process consistency and provider satisfaction

Meeting the Prior Authorization Challenge

Health Choice Arizona receives over 20,000 PA request forms per month from its physician providers that are submitted electronically or printed and filled out by hand. Despite implementing a web portal system and efforts to get physicians to go electronic, Health Care Arizona still receives 90% of PAs as faxed, handwritten documents As a result, Health Choice Arizona can’t use optical character recognition (OCR) technology to accurately process these requests. Instead, medical assistants had to manually enter the data for each handwritten request after printing out the document. This took anywhere from 30 seconds to an hour or more of routing and data entry for each fax, dominating the time of four assistants. The company’s three medical directors also spent more than half of their time reviewing authorizations. Looking for a better solution, Health Choice Arizona reached out to several providers seeking to automate the process. “We needed somebody to help us with the data entry plus give us a routing tool,” said Health Choice Arizona’s chief operating officer.” Only InStream was willing to do both. Everyone else turned and ran in the other direction when we brought this problem to the table.”

Creating a Streamlined Workflow

To begin, InStream set up a routing process using a FileBound workflow system. Doctors still fax in their handwritten authorization requests, but instead of being printed out, the faxed images are redirected to the InStream fax application. InStream then executes the data entry within 12 hours and submits the image and data over FileBound to Health Choice Arizona for approval or denial. The FileBound system also facilitates record-keeping, since notes and highlights the reasoning behind an approval or denial is retained in the system. And if an authorization needs to be looked up after the fact, it can be done instantly, whereas it previously would take more than 24 hours and $15 to $20 in total costs to retrieve a document from offsite storage. The system also enables physicians to go online to see the current status of their PA request instead of having to call for an update.

InStream & FileBound Workflow

Today, Health Choice Arizona realizes significant savings on paper and toner because it’s no longer printing 20,000 faxed PAs a month at 2-10 pages each. And while data entry processing previously took days, InStream turns it around in less than 12 hours with far fewer errors. “It has certainly improved our provider relationships because we’re turning things around a lot faster than we’ve ever done,” said the COO. Health Choice Arizona has been able to redeploy the four medical assistants who were previously doing data entry to tasks that would have otherwise required a net increase in staff. And the increased efficiency of the authorization process has enabled the organization to streamline from three medical directors who spent the majority of their time on PAs — at roughly a million dollars in combined salaries — to one chief medical officer who only needs to look at a handful of authorizations thanks to the enhanced workflow process.

About InStream

InStream provides enterprise content management (ECM) technology and outsourcing services for organizations seeking to automate manual, paper-intensive processes. We provide cost-effective mailroom, lockbox, document conversion, check scanner fulfillment, benefits enrollment, and data entry services for financial, healthcare, and government clients. We also provide the software, hardware, and professional services to implement document capture, management, and workflow — with special expertise in invoice processing and HR automation.

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