Automate claims, Reimburse quickly

Automate claims, Reimburse quickly

March 19, 2020

Claims Processing Done the Right Way

Automate claims, Reimburse quickly

To offer good health insurance plans, provide the two things buyers look for— value based payment models and quick reimbursement. Think claims processing software for success.

Healthcare payers play a central role in the realm of medical provisioning and care. Ensuring successful patient outcomes is as much the responsibility of payers as it is of providers. As the costs of hospitalization and medication increase by the year, it is essential that payers offer unique healthcare reimbursement models that ensure majority coverage and timely delivery of care.

In a Fix and Praying for Luck!

As a consumer of two insurance policies myself, I can vouch for the importance of prompt recovery of medical expenses. Few years ago, I underwent a minor surgery at a noted private hospital. Added to the costs of medication were other in-patient expenses including room charges and food. While I successfully recovered from the ailment, a lingering worry kept me awake on most nights— when will I get reimbursed?

The fact that I had just accepted a new job didn’t help matters— my corporate insurance cover would only kick into full gear upon my completion of the probationary period. This is a familiar situation for most 9 to 5 workers and part-time employees. But I would assume that even those who are well-placed in life would find a trip to the hospital to be an expensive engagement, given the rising costs of medical care.

Luckily, and to my surprise, I was reimbursed within 25 days of submitting my claims form. I only paid a fraction of the costs— one-fifth of the total premium for three years, to be precise. The rest was paid by my insurance firm. Given that the expenses were well within my coverage plan, the amount I received from insurance is not a big surprise. As a matter of fact, consumers are willing to pay for additional coverage offerings in an insurance policy if they are assured of timely reimbursements. So, apart from delivering price-attractive reimbursement models, it is vital that you work towards compensating patients as quickly as possible.

“Given how convenient the whole process was, I immediately bought a more comprehensive policy from the insurance company. This is the reaction you want from your policyholders and prospective customers! As a payer, if you are not adopting the latest claims processing software to service your customers, you are not only falling back on the technology curve but also reducing your chances of delivering quality service”

The way this was achieved is quite simple: the insurance firm I invested in had just digitized their claims management process, so much so that all the steps right from verification, validation, and approval to final payment was accomplished on a single platform, in real-time. It must be noted that if the healthcare institute falls within the network of providers serviced by the insurance firm, the claims process is much faster as the provider can directly submit the reimbursement form to the payer online.

Given how convenient the whole process was, I immediately bought a more comprehensive policy from the insurance company. This is the reaction you want from your insurance policy holders and prospective customers!

Why Automation of Your Claims Process Matters

Automate claims, Reimburse quickly

As a payer, if you are not adopting the latest claims processing software to service your customers, you are not only falling back on the technology curve but also reducing your chances of delivering quality service.

As the free economies around the world scramble to come up with a comprehensive healthcare package that accommodates consumers of all income levels, you can take the leap in this respect by leveraging claims processing software to

  • Establish new touch points
  • Build new price-attractive healthcare reimbursement models
  • Enhance customer experience
  • Create a portfolio of world-class providers (and)
  • Be a part of successful health outcomes

Extracting member data from the database such as the kind of policies and insurance packages your customers are opting for will also give you a chance to develop more conducive, patient-friendly reimbursement models.

The Cost of Poor Claims Management

A streamlined solution for claims processing will also reduce the economic burden of wrongful denial of claims— a blunder which could cost providers in the thousands, as was discovered by Change Healthcare in one of their studies — on average, at least 5%-10% of submitted claims are denied and 65% of those denials are never resubmitted. If we are to breakdown the costs of lost claims submission, it could result in a substantial loss of potential revenues— the average cost to file a claim is $6.5 whereas the cost to resubmit a denied claim ranges from $25 to $118 (Change Healthcare). Tie this to the total number of denied claims and you find that the cost of rework and resubmissions amounts to almost $150000 annually.

A comprehensive claims processing software with extensive electronic data capture capabilities will enable the automatic authorization of submitted claims after checking for missing or invalid claims data. With automatic data extraction features where thousands of medical forms can be digitized and processed in a matter of minutes, the solution gives you not just immense scalability but also eliminates duplicity and errors typical of paper based transactions. In a way, you as well as your providers will be assured of formidable risk management using this solution.

Also, as a payer, you will be building a cohesive ecosystem of providers, onboarding some of the best partner hospitals in the process. Because all providers are contacted through a common claims processing software platform, you will be in a better position to answer all queries related to claims payment and pre-authorizations from both hospitals and customers in real-time. Quick turnaround times for payments, easy communication with your network of providers and patients, and low operating costs— these are all winning solutions that will enhance your growth prospects in the long-run. Take a cue from leading payer organizations around the world and automate your claims process today. Success will follow.

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