Claims data entry is where the backlog lives
For most insurers, TPAs and benefits administrators, the slowest step in a claim is not the decision. It is claims data entry: getting what the provider wrote on the form into the claims system. Claims arrive on paper, by fax and as scanned PDFs from many offices, often with hand-written corrections. An examiner reads the form, searches the roster, picks the right person among namesakes and dependants, finds the provider and keys each service line. With experienced keyers harder to hire every year, the queue grows.
Each step is a place for a costly mistake: a claim paid against the wrong member, a fee missing a digit, a claim filed last week filed again. Generic claims processing automation rarely reaches the claims system itself; it stops at extracted fields, and someone still types.
How insurance claims automation works on your claims system
Claims intake from every door
Claim forms reach legacy bridge from an SFTP folder, an email inbox or an API upload: PDFs, scans, photos and faxes. A batch scanned into one file is split into one claim each.
Dental and medical claim form entry, read by AI vision
It reads claim forms such as ADA dental and CMS-1500 medical forms, and the variants offices print themselves, with no template per layout: subscriber and patient, provider, and every service line.
Find the member on the host roster
The agent searches your roster on the host and picks the member the form names, weighing name, birth date and member ID against each row. When two rows could be the patient, it holds the claim and shows a person both.
Find the provider
The treating or billing provider is looked up on your system, so the claim is filed against a provider record you already hold.
Apply your claim rules and key the lines
Your own claim rules, written in plain English, decide what each field gets. The agent keys the header and every service line, and reads each message the host returns.
Review, submit, confirm
An examiner approves the prepared claim in the web console before submission, until a workflow has earned the right to run on its own. The agent then reads the claim back from your system and logs it.
What every claim is checked against
Each claim is checked three ways before a key is pressed: against the form, against your rules, and against what your claims system already holds. The fields it keys are the ones your screens ask for: member and patient, provider, and for each service line the procedure code, date of service and fee.
- The service lines add up to the total the form prints
- Dates of service make sense against the date the claim arrived
- The member the form names is the member the roster row shows
- The provider exists on your system
- Your claim rules apply, such as which fields stay blank or when a claim is held
- The claim is not one already filed, by your team or by the agent
Exceptions, handled the way an examiner would
A claim already filed
A provider re-sends a claim, or a clerk already keyed it. legacy bridge compares it with the claims your system holds and catches the copy instead of filing it twice.
Not sure which member
A shared name, a dependant on the subscriber's ID, a birth date that disagrees with the roster: the claim is held with the roster rows it saw and the form image, for a person to pick.
Hand-written corrections
A fee crossed out and rewritten, a note in the margin that changes the meaning: parked with the ink cropped beside the field, never assumed.
The host says no
If your claims system refuses a line, the examiner sees the host's message and the screen. Nothing is submitted past an error, and a person's fix is remembered for the next claim.
In-house keying, outsourced keying, or legacy bridge
| Criterion | legacy bridge | Outsourced keying | In-house keying |
|---|---|---|---|
| Turnaround | As claims arrive, around the clock | Batches, on the vendor's schedule | Office hours and headcount |
| Member selection | Checked against the roster; holds when unsure | Depends on the keyer | Examiner judgement |
| Duplicate claims | Compared with claims on file | Often keyed again | Caught if someone remembers |
| Patient data | HIPAA-aware processing; email free of patient data | Leaves your walls with the vendor's staff | Stays in-house |
| Audit trail | Every keystroke and screen, hash-chained | A user ID on the record | A user ID on the record |
| Cost | Per claim filed and confirmed | Per claim keyed, right or wrong | Salaries and overtime |
Claims on AS/400 (IBM i) claims systems, under your controls
legacy bridge runs in production on IBM i (AS/400), including custom RPG and COBOL claims applications and packaged systems on IBM i. Nothing is installed on the host and no program changes: it connects as a terminal emulator does, over TN5250, through a secure SSH tunnel if needed, so it can process documents into AS/400 screens without an integration project and without the brittle scripts of desktop RPA. TN3270, VT, HP 6530 and legacy web portals are supported too, scoped per workflow with the same controlled proof.
Processing is HIPAA-aware and outbound email stays free of patient data. Every keystroke and screen is recorded in a tamper-evident SHA-256 hash-chained audit trail, and sessions can be replayed. The company behind it is certified ISO 9001, ISO/IEC 27001 and ISO/IEC 27017.
More: IBM i automation for insurance, automation for healthcare and dental benefits, the document types we handle, and why document AI alone leaves the entry to do.
