Defined Physical Therapy automates their Insurance Claim process reducing the time taken by 85% using Nanonets

Defined Physical Therapy Network, headquartered in Kennesaw, Georgia and led by Jessica Tehas works with patients who want to Return to Work, providing them with services like physical therapy and functional evaluation for disability applications, in adherence to the national Functional Capability Evaluation (FCE) framework.

Operating since 2017, with an employee count of 1-50 members, Defined Physical Therapy Network is a pioneer in the health and wellness industry and has successfully carved a niche out for themselves.

• Location: Georgia, United States of America
• Year of Establishment: 2017
• Leadership: Jessica Tehas (CEO)
• Industry: Healthcare
• Employee Count: 1-50 employees
• Revenue: US$ 1-5 Mn.

In order for a patient to receive treatment by one of the network providers, they must either confirm if they are a private or insured individual. Private patients go straight to billing, but insurance claims must go through the relevant insurer.

When the patient is insured, the insurer will complete an NUCC (National Uniform Claim Committee) insurance form which approves the treatment. Due to the amount of insurers, this can be a complex process to analyze.

Let us take a deeper look at the billing process that was followed at Defined Physical Therapy Network for processing Insurance Claim forms:

1. Customers get referred to Defined Physical Therapy Network for Return To Work services, that range from physical therapy to disability evaluation.
2. Private patients can go straight to billing but for Insured customers there is a clearance required from their insurer.
3. The HFCA / CMS - 1500 Insurance claim forms are filled by customers and scanned. These scanned insurance forms are faxed or emailed to Defined Physical Therapy Network.
4. Relevant patient details have to be manually filled out in their internal CRM and filed with the insurer for claims.
5. The filing of the insurance claim with manual data entry took about 11 minutes for a single patient. The team was manually processing over 60,000 pages on an annual basis.

Nanonets understood the entire manual process and rose to the challenge of automating it. We ingest forms directly at the source, which is Gmail or G-Drive, automatically extract the relevant data points, format them, and export them via webhooks to the internal proprietary CRM at Defined Physical Therapy Network.

Let’s take a look at the automated process with Nanonets:

1. Import: Nanonets ingests the incoming insurance claim forms directly at the source, which is Gmail or G-Drive.
2. Data Extraction: The AI-powered custom OCR model at Nanonets extracts the relevant data points from the claim forms.
3. Post-Processing: This data then flows through a number of post-processing formatting steps such as finding and replacing characters, removing characters, etc. to clean up the extracted data.
4. Export: This data is then transferred to webhooks where it gets exported to the internal CRM at Defined Physical Therapy Network. The claim gets categorised and the team can file the claim with the respective payer.