Automated Claims Processing (ACP)

Automation plays an increasingly important role in the global economy and in daily experience. Engineers strive to combine automated devices with mathematical and organizational tools to create complex systems for a rapidly expanding range of applications and human activities. Automation (ancient Greek: = self dictated), roboticization or industrial automation or numerical control is the use of control systems such as computers to control industrial machinery and processes, replacing human operators. In the scope of industrialization, it is a step beyond mechanization. Whereas mechanization provided human operators with machinery to assist them with the physical requirements of work, automation greatly reduces the need for human sensory and mental requirements as well.

There are still many jobs which are in no immediate danger of automation. No device has been invented which can match the human eye for accuracy and precision in many tasks; nor the human ear. Even the admittedly handicapped human is able to identify and distinguish among far more scents than any automated device. Human pattern recognition, language recognition, and language production ability is well beyond anything currently envisioned by automation engineers. We specialize in three types of automation:

• Specialized computers and computer language are frequently used to synchronize the flow of inputs with the flow of outputs. This leads to precisely controlled actions that permit a tight control of almost any industrial process.
• Another form of automation involving computers is test automation, where computer-controlled automated test equipment is programmed to simulate human testers in manually testing an application. This is often accomplished by using test automation tools to generate special scripts (written as computer programs) that direct the automated test equipment in exactly what to do in order to accomplish the tests.
• Finally, the last form of automation is software-automation, where a computer by means of macro recorder software records the sequence of user actions (mouse and keyboard) as a macro for playback at a later time.

Currently, in many companies, the purpose of automation has shifted from increasing productivity and reducing costs, to broader issues, such as increasing quality and flexibility in the manufacturing process. The old focus on using automation simply to increase productivity and reduce costs was seen to be short-sighted, because it is also necessary to provide a skilled workforce who can make repairs and manage the equipment. Moreover, the initial costs of automation was high and often could not be recovered by the time entirely new processes replaced the old. But those days are long gone!

Many of our engineers here at S.E.E.D.^© Technology Center have spent their entire careers in the area of automation; working with such companies as the California Credit Union League, Rockwell-Collins, UPS, BlueCross & BlueShield of South Carolina, and Palmetto GBA, they have created some of the most sophisticated and comprehensive automated process in the field of claims processing that there are today.

Examples of ACP include:

• Generate Microsoft Word documents or business forms from data stored in other applications such as Microsoft Access, Microsoft Excel, SQL or Oracle.
• Generate presentations from external data.
• Automatically send emails to customers or groups in Microsoft Outlook.
• Create custom data entry mechanisms for Microsoft Office Documents.
• Maintain and organize data stored in Microsoft Excel, Microsoft Access, SQL or Oracle.
• Extract data from PDF files for further processing.
• Create stand-alone executables to automate your office environment.

For several decades, medical billing was done almost entirely on paper. However, with the advent of computers it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market. Several companies also offer full portal solutions through their own web-interfaces, which negates the cost of individually licensed software packages.

In an effort to leverage these companies technology, S.E.E.D.^© Technology Center has developed claims processing software and procedures to enhance any organization ability to price healthcare claims efficiently and cost-effectively.