To Implement Six-Sigma in Health Claims Processing

We do a significant amount of claims processing and have not implemented six sigma.  I also would be interested in hearing from someone who has.  We outsource most of the data entry as well and monitor the quality of the processing using random QA audits.

I am also looking at improving our claims processing, specifically pap smears, (we have a very large women’s center practice).  I am in a newly created position “Coordinator of special projects” and yes, this is one of my special projects.  I would appreciate any help that you are offering.

HI! Beth
We are also in the same field of Health Claims Processing and we also follow a similar work flow process , I have done some  work in Six-Sigma  for my company , I am also in search of some extra inputs from somebody . Please share your problem in detail , only then will I be able to give you a proper solution .
Thanks & Regards
 
Shashank Rangole
Senior Officer – Process Improvement
Location – Mumbai , India

Here are some general parameters that should give you a v good indication on the efficiency of your claim processing:
a) number of claims worked vs number of claims denied.  Denied claims should be further categorized into reject (write off) or rework, b) turn around time per claim per worker per payor and c) # claims per worker
Also visit the advisory.com web site and look for best practices in the field.  If you need additional info then email me at [email protected]. Hope this helps!

Dear All
Please don’t be formal in sharing the information on the crutial issues like this be bold & provide the data or atleast the formatt of the project the problem with me is I recently join six sigma and wana targetted approach towerds it working for a hospital & want to improve the recievable from Insurance companies
help me Please send on [email protected]

Dave, both Lean and Six Sigma have tools that are applicable to your sector depending upon the expected outcome of your project.  In fact, a hybrid approach may be best.  What is the nature of the issue you are trying to address?  Are you trying to increase the overall efficiency of the process (i.e., eliminate wasted effort).  Or, are you trying to control the process to ensure consistent service delivery, outcome specs, timing, etc.?  The former is best addressed with a Lean approach while the latter may benefit from a Six Sigma approach.
Lean and Six Sigma are not industry specific; rather, the process need will determine which methodology may best support your improvement efforts.  Also, a simple 1-2 week kaizen event may be all that is needed to scope your area of need and define a solution (implementation may take longer).
Please feel free to contact me directly for a more detailed discussion on how Lean and/or Six Sigma may be best applied to your issue.
Erik Jerman, PricewaterhouseCoopers813-222-7091 [email protected]