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To Implement Six-Sigma in Health Claims Processing

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Viewing 12 posts - 1 through 12 (of 12 total)
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  • #25069

    Shahshank
    Member

    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.

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    #60249

    Jeff Hollister
    Participant

    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.

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    #60252

    Vinod Gopal
    Member

    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.

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    #60307

    Ludwig
    Participant

    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.

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    #60312

    Shashank
    Member

    HI! 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
     
     

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    #60313

    Shashank
    Member

    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

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    #61338

    Ver
    Member

    I 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]

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    #61345

    Thomas
    Participant

    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]dical.org. Hope this helps!

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    #61875

    Ropp
    Participant

    Hi 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]

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    #61879

    meer
    Participant

    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]

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    #61899

    Solution guy
    Member

    Meer,
    Check out http://www.biproinc.com.  They could be a good partner to help you.
     
     

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    #61900

    Manning
    Participant

    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]

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