Skip to main content

Challenge The Inefficient Status Quo In Claims Administration

Today, many health plans use homegrown or legacy systems that assume manual work as part of the process. With limited automation and integration, organizations spend valuable time and money on administrative tasks that could be simplified.

Claims processors often need to work on disparate systems. They can sometimes spend hours cutting and pasting information and keying or re-keying in data from one screen to another when they could be focusing on more productive tasks like handling increasingly complex claims or process improvement.

But the healthcare industry is dynamic, and health plans must evolve to meet the demands of the changing market. Technology plays a massive role in enabling us to embrace change. Next-generation technology solutions support centralized payment ecosystems that bring all aspects of claims payment processes together to deliver payment integrity prospectively before providers are paid.

Technology and innovation are key to remaining competitive in the healthcare industry today, and organizations should be evaluating their current payment ecosystem. Ask yourself these questions about your claims payment ecosystem. Can you:

  • Connect to multiple claims systems and support all lines of business?
  • Perform editing and pricing in a single pass?
  • Allow for customization and configuration to match your business rules without creating workarounds?
  • Provide complete information to support claims reviews, audits, and provider relations teams?
  • Deliver advanced real-time analytics and claims modeling?

If no was the answer to any of the above questions, it might be time to explore new technology, discover its capabilities, and unlock endless possibilities.

In today’s world, health plans need a technology solution that can easily integrate with their core administrative processing system and make it work smarter. Payers should challenge the inefficient status quo in claims payment administration and invest in a technology that will enable innovation, accuracy, and operational efficiency.