Effective claims operations through scaled digital adoption
Taking a leap from inefficient legacy systems
If you found a proven way to increase revenue, reduce errors, and improve customer satisfaction — would you take advantage of it?
Healthcare payers spend 85% to 90% of their revenue on claims payments. Yet, fears about costs, training, and data loss can prevent insurers from updating their claims management systems. They continue to use legacy systems and manual, siloed operations, which frequently lead to pricing and billing errors, incorrect claims denials, and long processing times.
The benefits of digitizing, consolidating, and automating processes far outweigh the risks. Upgrading claims operations through AI and machine learning can vastly reduce errors, accelerate processing times, enable intelligent fraud detection, and reduce financial burden.
What digital transformation can do
While concerns about transitioning to a new system are understandable, steps can be taken to mitigate risk and optimize results.
An experienced IT team can work with your business to build and modify models and processes for minimal disruption and best results through the transition period and beyond.
Digital efficiencies can:
- Convert paper and fax claims to electronic claims, reducing manual effort.
- Verify most claims and flag claims requiring administrative input.
- Assess the complexity of a claim and route it to the appropriate adjudicator depending on skill set and workload.
- Analyze pending claims and provide insights for the claims adjudicator.
- Automate fraud detection, coordination of benefits, and medical attachment submissions, improving the auto-adjudication rate.
Accuracy, speed, and efficiency all add up to better customer experiences and increased revenue. Payers who upgrade to best-in-class systems see cost savings of 25% or more, giving them a notable edge over competitors that use industry standards.
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