Since Medicare required electronic claims submission in 2003, plans have relied on auto-adjudication to process, pay, and track claims efficiently. Leading plans target auto-adjudication rates in the high 90s, but system errors, faulty matching logic, inaccurate information, and missing contracts can trigger rejections or costly manual work. Maintaining accurate data and investing in high-volume adjudication engines are essential for operational efficiency. Configurability is equally important, allowing plans to quickly adapt to CMS regulations, benefit changes, provider contracts, member updates, and other variables. In this episode, discover how modern claims technology can reduce costs, improve performance, and keep plans competitive.
About Our Guest
Kirsten Lynch is a product manager and claims technology expert who has been in the healthcare industry for over 20 years.