The challenge
Poor processing of medical claims can lead to non-competitive administrative costs and customer defections. But prompt accurate claims processing can help payers decrease operating costs and increase market share and profitability. A disciplined approach to claims processing and collaborative relationships with providers can streamline transactions, increase accuracy and decrease cycle times. Create loyal members and healthy margins.
How we can help you
You should evaluate the effectiveness and efficiency of your claim-processing practices. We can carefully examine the operations and management of your claims processing. We can help you implement leading practices into consistently applied procedures. We can review audit reports to uncover targets for improvement. We can conduct process mapping of current adjudication and its upstream functional interface.
When you discover mistakes or deficiencies in processing claims, you need to determine quickly whether they are isolated or systemic, and swiftly develop appropriate remedies. We can conduct a root cause analysis of claims-processing errors, looking at the people, processes, data and technology that support claims processing. We can review your performance-management systems and develop plans to resolve reported system-related issues.
Common services include:
- Reviewing audit reports from employer groups and departments of insurance, metrics, policies, process maps, training manuals and other departmental information
- Process mapping of current adjudication and upstream functional interface
- Reviewing performance-management systems and reported system-related issues
