The Joys of Automating Your Claims Adjudication Process
The technological revolution is making an impact in the way medical claims are processed, particularly when it comes to claims adjudication. Gone are the days when payers had to rely on manually intensive work to process a high volume of claims, precluding them from meeting efficiency targets.
Today, companies have the ability to streamline processes at a faster pace thanks to auto-adjudication. By definition,
auto-adjudication is the process of approving or denying claims coverage faster, better, and smarter. This tech-enabled process has been designed to accelerate screening and validation, ensuring providers and patients interact with enhanced transparency.
The goal of automating this tedious undertaking is to reduce the amount of people engaged in manual adjudications, giving them enough room to shift their attention and efforts to high-functioning tasks, increase turnaround times, and deliver smoother claim experiences.
A recent study found that
80 percent of submitted claims are auto-adjudicated with limited manual interventions, whereas the remaining 20 percent still relies on manual inspections which, for the most part, pertains to high costs and complex medical billings.
This suggests that organizations are gradually embracing the new technology. Yet, understanding technology adoption may be more cumbersome than we think, particularly when we add claims submissions to the equation.
Despite the popularity of
electronic medical records, both payers and providers are still traditional submissions including paper, email, and faxed-based claims.
For example, Medicare reported that, out of 61 million registered individuals,
50 million submitted handwritten claims in 2019. This resistance not only delays the widespread use of auto-adjudication, but also precludes payers from creating business value.
Automating Your Claims Adjudication Process Comes with Significant Benefits
Doing more for less seems counterintuitive, but it is the norm for automation. Digital tools are now turbocharging organizations that initially failed to connect with today’s view of managing talent, networks, innovative processes, and technology.
As auto-adjudication hogs the spotlight in the efficiency imperative, it is vital to point out the enormous benefits of embracing automation in your claims adjudication process.
Faster Claims Processing
Automation turns complex tasks into stress-free, touchless operations that you can exploit to be in control of the claims life cycle. A customer service study made by Accenture found that 95 percent of participants place fast claims processes as the most important factor in their level of satisfaction.
By automating your claims adjudication process, you are not only maximizing efficiency but also taking care of your customers (patients) and expediting settlements.
More Time to Focus on High-Impact Tasks
A recent study on employee satisfaction found that by 2030 people at work will spend more time developing advanced technology skills. Furthermore, industries like healthcare will also experience a bigger demand for people with powerful soft skills to improve the patient journey.
With that in mind, auto-adjudication will allow your staff to concentrate more on high-impact tasks, like assessing highly complex claims, developing insight-driven strategies with large volumes of data, or finding training opportunities to deliver a better service.
Lower Operational Expenses
Using leading-edge technology to fast-track your auto-adjudication enables you to better manage two critical resources: time and staff.
According to a recent study on automation programs in the private payers arena, automated tasks bring operational expenses down to
30-40 percent, while doubling efficiencies. Haven’t you seen the bigger picture yet?
Zooming in on claims efficiency through automation helps your team not only reduce your operational costs, but also allocate more funds in the pursuit of automation improvements or tap into other equally important, bolt-on technologies that could trigger more savings, reaching a goliath level of efficiency.
Better Services for the Modern Patient
We started a new decade with a health crisis at the door, walking us through a digital revolution that is currently reshaping patient expectations at a faster pace. An online survey in 2019 found that only 29 percent of Millennials were satisfied with the quality of the healthcare system, which includes payment among other patient-related processes.
Furthermore, 92 percent of consumers expect to be informed about their payment responsibilities in advance and prior to visiting a provider. These findings suggest that your claims processing, importantly auto-adjudication, should match the persisting expectations of the modern patient.
Focus on claims adjudication that accelerates turnaround times, which can only be enhanced through the right use of automation.
Ready to Automate Your Claims Adjudication Process?
Adding efficiency to your claims management process makes all the difference in today’s digitally progressive world. As we covered, auto-adjudication does not just help you accelerate your performance, but also improves the quality of your service.
There is no question that automation makes things easier, but now is the time to choose the right software solution to turn challenges into exciting opportunities.
Our
QuickCap 7 solution comes with a range of features that will enable your team to manage claims, including adjudications, like never before.
QuickCap’s Rule-Based Adjudication at a Glance
With our AI-assisted software solution, you will be able to:
- Handle various claims formats like EDI files, scanned claims, and more!
- Combat fraudulent and invalid claims
- Set EDI standards to communicate between trading partners
- Power eligibility and authorization work with rule-based configurations
- Secure reliable payment calculations with greater accuracy
Hold on! QuickCap 7 also helps your organization streamline administrative and clinical processes at a competitive level.
Keep track of changing data - Personalize your dashboard according to your needs and stay connected with your workflows using our powerful task management system.
Automate the repetitive - Notice the difference between age-old systems and our modern approach towards faster claims processing and boost productivity.
Forge an insight-driven business - Use our reliable risk-stratification and predictive analytics tools to make well-informed decisions and build confidence throughout your business.
Winning the claims adjudication game in healthcare can be troublesome. But we are always open to discuss how QuickCap 7 can make a difference in your organization by streamlining the manually intensive tasks that stop you from scaling your organization.
Automate Your Claims Adjudication Today
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