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Claim Sense uncover innovative ways in process claims effectively and efficiently while keeping the cost optimized

Healthcare Payor's Claim Process Transformation

Industry Pain Points

Healthcare payers are facing two major challenges in the current healthcare landscape. They need to ensure operational efficiency and lower the claims processing cost in a rapidly changing industry. About 20-30% of claims require manual handling, leading to "pending" statuses and additional fees. Furthermore, processing low-value claims is often more expensive than their actual value, which makes it difficult to decide whether to automate, auto-adjudicate, or handle them manually.

Per Claim Processing Cost: >$30
Average Claim Processing Time: 30 Days
First-pass Claim Acceptance Rate: 80%
Average Claim Backlog: 25%
Claims Auto-adjudication Rate: 60%
Claim Denial Rate: 15%

Our Solution

Transforming Healthcare Payors' Claims Operations, our innovative approach swiftly addresses pending codes through comprehensive dependency insights. This method halves claim iterations, significantly reduces claim cycle time, and results in substantial cost savings. The outcome? A remarkable 12% decrease in operational expenses, highlighting the solution's ability to optimize Healthcare Payors' Claims Operations. Additionally, our solution achieves a 40% auto-approval rate for low-value claims, elevating claim operations to unparalleled levels of efficiency and effectiveness.

Uncover Pend Dependency

Leveraging cutting-edge Process Mining technology, our solution meticulously analyzes historical claim data, pend codes, and resolution steps to pinpoint specific pend codes and tailored resolution paths for each claim type and characteristic. This in-depth analysis equips Claims Operations with actionable insights and personalized guidance, streamlining claim adjudication processes for enhanced efficiency.

Streamlined Low-Value Claim Management

Our solution streamlines the processing of low-value claims by offering insights to guide decision-making on auto-adjudication or automation, reducing dependence on manual processes and ensuring a more efficient claims management system. This innovative approach helps payors realize substantial operational cost savings and improve auto-adjudication rates, resulting in a more efficient and responsive claims processing environment.

Features

Claims Performance Overview

Streamlines claims management by offering insights into total claims, turnaround times, rejection rates, occurrences of rework, manual interventions, and approval rates.

Claims Analytics Comparison

Evaluates effort, cost, cycle time, and rework, comparing low-value and pend-dependent claims with standard ones to optimize claim processing efficiency.

Pend Dependency Insights

Provides claims agents with valuable insights into dependencies related to pending codes, facilitating quicker adjudication for faster claim settlements.

Low Value Claims Analytics

Delivers insights empowering owners to discern patterns for auto-adjudication or RPA, thereby reducing manual claims processing effort.

Claims Performance Overview

Streamlines claims management by offering insights into total claims, turnaround times, rejection rates, occurrences of rework, manual interventions, and approval rates.

Claims Analytics Comparison

Evaluates effort, cost, cycle time, and rework, comparing low-value and pend-dependent claims with standard ones to optimize claim processing efficiency.

Pend Dependency Insights

Provides claims agents with valuable insights into dependencies related to pending codes, facilitating quicker adjudication for faster claim settlements.

Low Value Claims Analytics

Delivers insights empowering owners to discern patterns for auto-adjudication or RPA, thereby reducing manual claims processing effort.

Benefits

Cost Saved: 30%
Reduce Turnaround Time: 40%
Increase Auto-Adjudication Rate: 35%
Increased First-Pass Rate: 45%
Automatation Saved: 18 FTE

Here’s how to get started

Effortlessly unlock business success by connecting with a dedicated Advisor, receiving a personalized Technology Roadmap, and focusing on business growth with your technology needs in capable hands.

30 Days Free.

Our experts will guide you and uncover actionable process improvement opportunities by seamlessly integrating with your source systems in the trial instance.

Business Review.

We offer solution walk-throughs and process improvement insights, enabling you to evaluate and validate improvements, ensuring measurable return on investment. Experience impactful results tailored to your business needs.

Grow Your Business.

Now that you have validated the solution and business benefits, you can focus on running your business and staying ahead of the competition.

Why Choose Us

50+ Years of Technology Expertise

Our wealth of experience has equipped us with the proficiency to deliver exceptional services to you.

4K+ Processes Modeled

We have effectively assisted organizations with capable process modeling to enhance productivity.

50+ Certified Consultants

Our team, with extensive knowledge, provides the best service and support to meet your needs.

1000+ Tasks Automated

We have successfully automated processes with enormous results benefiting the organization.

Let's get started today

Because we put you first. Our customer-obsessed working model honors client's needs.

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