To Implement Six-Sigma in Health Claims Processing
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Manning.
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August 12, 2004 at 3:38 pm #25069
ShahshankMember@ShahshankInclude @Shahshank in your post and this person will
be notified via email.I am working as a senior executive in process improvement. Our company outsources a majority (about 60%) of our production processes like data-entry. The remaining 40% of the work includes planning, work allocation, monitoring, QC and final delivery to customers. Our company has implemented Six Sigma, but I want to implement Six Sigma for two health claims processing projects which I have been assigned. Can anyone guide me as to what Six Sigma tools should be used and how should I go about getting started? Also, please suggest whether COPC standards can be used in my company.
0September 1, 2004 at 6:40 pm #60249
Jeff HollisterParticipant@Jeff-HollisterInclude @Jeff-Hollister in your post and this person will
be notified via email.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.
0September 2, 2004 at 10:19 am #60252
Vinod GopalMember@Vinod-GopalInclude @Vinod-Gopal in your post and this person will
be notified via email.Jeff,
My name is Vinod Gopal and I work for the competency development department for a Healthcare billing company. We have staff who have come from Insurance claims background and have obtained Six-Sigma green and black belts. I will have them touchbase with you if you’d like to. My e-mail address is
[email protected]
Please feel free to mail me your areas of interest and the ways my co-workers can assist you and I shall have them correspond to you back.0October 4, 2004 at 7:50 pm #60307I 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.
0October 6, 2004 at 2:47 am #60312HI! Jeff
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 problems and 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
0October 6, 2004 at 2:52 am #60313HI! 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 , India0January 20, 2007 at 12:21 am #61338I know that it is an old issue but if you can provide me your process and which of these were outsource then I can help you on your problem. Currently I am in charge in handling different problems in our claim processing company.
Thanks
Ver
my email is [email protected]0January 26, 2007 at 5:12 pm #61345
ThomasParticipant@MauriceInclude @Maurice in your post and this person will
be notified via email.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!0February 20, 2008 at 4:32 pm #61875Hi All,
We are Healthcare Claims Process company dealing in Payer and Provider business of Revenue Cycle Management. We are trying to implement Six Sigma Process Standards with our current process.
If anyone there who have extensive experience in Six Sigma Project implementation, please help me out with some guidelines especially for Claims Processing Process. If anyone share his/her project will be really boon for me.
Looking forward for valuable inputs/suggestions.
Best Regards,
Dave S.
[email protected]0February 23, 2008 at 11:24 am #61879Dear 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]0March 6, 2008 at 10:19 pm #61899
Solution guyMember@Solution-guyInclude @Solution-guy in your post and this person will
be notified via email.Meer,
Check out http://www.biproinc.com. They could be a good partner to help you.
0March 12, 2008 at 1:30 pm #61900Dave, 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]0 -
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