1. CASE IN FOCUS
AUTOMATION OF CLAIMS SEGREGATION AND REAL TIME
IMAGE SEARCH FOR A LEADING HEALTH INSURANCE PAYOR
INDUSTRY
HEALTH INSURANCE
LOCATION
Kansas, U.S.A.
DETAILS
The client, a leading Health Insurance Payor operating
in and around the state of Kansas, has been in
contracts with wide range of brokers, and offered
various Health Plan products to more than 500
employers until now.
CHALLENGES
 Claims Segregation
 Tracking Claim status
 Adjudicating high Dollar claims
SOLUTIONS
The core modules of the solution are:
 Tool which segregates images
 In-house application for updating
claim status
 Dedicated team for analysing
claims
 Dedicated team for tracking
claims
 Trade Promotions
 Sales Force Productivity

2. CASE IN FOCUS
“We had stringent specifications while choosing
our solution partners. Vee Technologies qualified
to be the most preferred one because of the well
thought out approach it laid out, and for the
quality of work it had displayed, all through the
years, ever since it came into existence. The
preliminary meetings were sufficient for us to
gauge that Vee Technologies would be the best
solution provider for us, in all respects.”
- COO
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BUSINESS SITUATION
The client is a leading health care insurance payer operating in
and around Kansas. Primarily, the insurance claims sent by
brokers, insurance providers, clearing houses, and other
networks, are processed by the client’s team, and payouts are
done accordingly.
Insurance claim processing requires high levels of accuracy, and
fine scrutinizing of the available data. The success of the client’s
business relies on how effectively the verification process is
done, and how fast the operational transactions happen. Apart
from being tedious, the handling of incoming claims can get
delayed due to redundant steps, and poorly automated tasks.
The client, being among the most revered in their industry
wanted to clean up their processing style, and imbibe latest
technological aids to fasten up and smarten up their operations.
The major issue to tackle was claim segregation. Since the client
got 2000+ paper claims from various sources each day, it was
extremely challenging to segregate them based on different
groups or PPO networks.
Another issue that hindered the operations was that there was
no definite method followed to keep track of the status of each
claim that was being processed. Every time this information was
needed, the database had to be consulted. This did not just add
on to the processing time, but also resulted in redundant checks
and unclear claim status.
Adjudicating high dollar insurance claims was the other issue
that the client struggled with. A lot of time and effort had to be
invested on the verification process, which made it simply
impossible to wrap up the tasks in time. Furthermore, when
claimants came back with additional information for accident,
DME, surgery claims and so on, the client had no easy way to
keep a tab on them, and recognize them as closed or held up.
Also, while addressing claimant queries, the client’s customer
service executives struggled to retrieve the adjudicated claim
copies. It required a lot of manual effort to segregate the
images, and load everything to the real time server for making it
available on the CSR.
Thus the client was looking for alternate solutions to address
the segregation, claim status, adjudication and information
retrieval issues.

3. CASE IN FOCUS
THE HUNT FOR THE RIGHT PARTNER
The client, being particular about the quality of the
solutions, went far and wide to connect to the right
partner for this job. After reviewing various proposals and
solution ideas, Vee Technologies was considered to be
among the client’s top choices because of the
innovativeness it presented in its solution proposal.
Within a couple of initial meetings, the client was
convinced that Vee Technologies was the right partner to
cater to their current process issues. The client was
especially impressed with the freshness of the ideas, and
the clarity with which the problem was analysed, to
derive the most optimum solution steps. Additionally,
since Vee Technologies is a market leader and a creator of
various automated solutions, the client was completely
convinced that Vee Technologies will deliver the best
solution that’s powered by technology, and driven by
years of experience.
VEE TECHNOLOGIES’S EXPERT SOLUTION
The client was very specific about getting a system that
would ease out their day to day operations, and lessen
the amount of time that was being consumed to finish
the process. Vee Technologies grasped the requisites with
all its subtleties, and came up with a comprehensive
solution that entailed right amount of automation and
manual effort.
The formation of solution started with the breakdown of
current process to understand it better. The process
bottlenecks were then analysed to design a solution that
would eliminate the loopholes, delays and redundant
procedures. The solution structure was also optimized to
be reused for various purposes. This approach enabled
Vee Technologies to provide a smart system to tackle the
issues the client was facing.
The first solution that Vee Technologies came up with
was an application to segregate images. This tool
developed by Vee Technologies scans through all the
incoming claim images, groups them up based on their
network, and places them in predefined locations. These
segregated claim images will then be auto-loaded to the
real time server. This sorted out the segregation issue of
the client.
To keep track of the claim status, Vee Technologies
developed an in-house application. This tool updates the
status of every claim, and sends batch wise status
information to the client. It also generates output files
within no time.
For analysing the incoming claims, Vee Technologies
provides the client a dedicated team that works
relentlessly in the backdrop. Vee Technologies
automatically sends a bill request letter, on behalf of the
client, to the provider. On receiving the itemized bills, the
client forwards them to Vee Technologies. The dedicated
team of Vee Technologies then thoroughly reviews every
item of the bill to point out any non covered drugs or
services. The result of the review is sent to the client’s
high committee review team. The entire set of claims
sent to Vee Technologies is documented, and detailed
reports are generated. This report helps in fastening up
the process, and closing the claim requests quickly.
To handle the issue with multiple correspondences from
claimants, Vee Technologies’ dedicated team receives all
the additional correspondences from the client, and
generate a correspondence log. This helps in keeping
track of each correspondence, and in knowing the status
of the reworked claims.
Additionally, Vee Technologies built an application to
capture every claim that comes in, and to convert the
output into EDI format. The EDIs go directly into the
client’s adjudication system where claim images will be
assigned with unique claim numbers. The numbered
image copies are then loaded on to the real time server
from where they can be retrieved based on various
selection criteria. To protect the system from third party
intrusion, users need to give authenticating data before
logging in.
The solution addressed all the issues, and helped in
speeding up the process. The dedicated teams provided
by Vee Technologies work hand-in-hand with the client to
render high quality service, and precise adjudication. This
increases the efficiency of the process, and widens the
client’s bandwidth to cater to more claims.
“Vee Technologies’ solution was comprehensive
in nature, and helped us not only address the
issues, but also enhance the effectiveness of the
process”
- CFO
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4. CASE IN FOCUS
Vee Technologies USA
USA
New York
90 Park Avenue
Suite 1700
New York, NY 10016
Tel:646 837 0837
Fax:646 350 3837
info@veetechnologies.com
ABOUT VEE TECHNOLOGIES
Vee Technologies USA was founded in 2010 to bring improved
‘local’ service to our customers. Headquartered in New York City
but with offices and teams spread across the continental U.S., our
experts are Americans who spent their careers in top companies
like Accenture, IBM and more.
Today we offer a full range of back-end transaction processing
capabilities for the Insurance, Healthcare, Logistics, Legal, Finance
and Accounting and Engineering industries. For more information,
please visit www.veetechnologies.com.
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BENEFITS THE CLIENT OBTAINED OUT
OF VEE TECHNOGIES’ SOLUTION
The best part of the solution was that it was completely
client oriented. Vee Technologies ensured that every new
step that was being formed would make the client’s job
easier, and the process better.
The automated segregation facilitated easy grouping of
claims with no manual error. It also saves a lot of time,
and makes the claim processing much easier. The status
of the claims can now be easily monitored with the
spreadsheet that the system generated.
The high dollar claims that are handled by the VeeTech’s
dedicated team are tracked in detail, and the client gets
an easy to understand list of ‘ready to pay’ claims. This
list has all the required information to decide the payout
percentage.
The reworked claims are processed and put into a
log based on the correspondences that have
occurred. This log helps the client know the exact
status of every reworked claim, with no additional
efforts. Finally, with the central real-time server
having all the details of the claims, the client is able
to access any required information from any part of
the world.
The most appealing part of the entire solution is that
there is no need for the client to follow up or
overlook the process proceedings. Vee Technologies
provides end-to-end service from its side.
The deep commitment displayed by Vee
Technologies, and its dexterous execution certainly
has impressed the client to a great extent, and led to
a long term professional alliance between both the
parties.
“Automate your processes, get the required support, and obtain finely
designed solutions, from Vee Technologies, to scale up your business
and to add oodles of efficiency to your system.”