Case Study: Tufts Health Plan achieves triple claims throughput and reduces error rate to 0.2% with FIS FormWorks

Deliver Greater Productivity and Efficiency Streamline Claims Processing to Improve Performance and Compliance

Tufts Health Plan, a healthcare insurer founded in 1979, faced rising pressure to boost administrative productivity and reduce errors from manual paper-claim data entry while meeting enhanced data-security requirements (including Department of Defense standards). To address these challenges, Tufts engaged FIS and moved from Entrendex to FIS’s FormWorks solution to modernize claims processing.

FIS implemented its FormWorks web-based keying platform, working with Tufts to reconfigure business rules and install browser-based workflows that limited sensitive data stored on keyers’ machines. The results were dramatic: throughput per keyer rose from 55–60 to over 150 documents per hour, error rates fell from 3% to 0.2%, penalties from miskeyed claims were greatly reduced, data security improved, and ROI and productivity targets were achieved in under two years.

Tufts Health Plan

Rob Wald

Manager, Provider Technology