Optimizing your claims processing in five easy ways

By Tilak Sharma - CEO

Faster claims processing equals greater customer satisfaction

One of the biggest truths in claims processing is that the faster you deliver claims resolution, and the quicker you are to respond to inquiries, the happier your policyholders will be.

Claims processing is a time-sensitive and critical aspect for a healthcare payer, and payers are continually under tremendous pressure to meet customer expectations. So how quick are your processes to handle this kind of pressure and deliver on the most vital aspect of your business – that of a positive customer experience?

Unfortunately, the claims process is time-consuming and labor-intensive, often relying on outdated technology across different business units. Frequently, this results in delayed claims processing and other quality issues, leading to negative customer experiences.

Claims processing is also the most considerable expense for a healthcare payer. Do you know that claims payouts and loss-adjustment expenses can eat up to 80 percent of your revenue? Therefore, improved claims processing can directly correlate to your profits and long-term sustainability.

The solution lies in the optimum use of sophisticated software and by re-imagining process workflows. With streamlined and optimized information workflows across business units, you will notice an immediate increase in sales efficiency and improved customer service.

1. Scan, digitize and validate incoming claims

Going digital is the only way to manage the massive volumes of data that turn up at your processing center daily. Most healthcare payers have already installed primary forms of automation in their systems. However, to stay competitive and to remain relevant in an increasingly challenging marketplace, it is critical to up the ante. Investing in technology, like document digitization through scanning, data capture and electronic forms is no longer optional but necessary for faster and accurate claims processing.

2. Auto-classification of documents

Before automation, the classification of documents was labor intensive, error-prone and time-consuming. Technology has significantly improved this business process, helping payers reduce labor costs, enhance information quality, and become more efficient. For example, intelligent data capture software has reduced the time involved in manual document preparation and enhanced quality of scanned images.

3. Robotics and Machine Learning

Scanning, extracting and validating the data on a claim, form or document is now done seamlessly, in a single step. The resulting data capture accuracy, faster processing, better information access and reduced processing costs lead to speedier and accurate claims processing and greater customer experiences. So if you’re looking save time and money, both, investing in process automation is a smart decision.

4. Higher First Pass Rate

While insurance claim processing is complex, but this multi-step process can be simplified if it begins correctly. It is possible for a claim to get processed accurately the first time itself if the right technology has been implemented. Every step of the process is an opportunity for the payer to identify areas for improvement that can speed up the overall process in order to reduce time and costs. With the right technology, it is possible to look for the correct information on the claims document to determine if the claim is complete and get the documents into the workflow.

5. Outsourcing is key

Outsourcing the insurance claims process or part of it is not simply a cost-saving decision. Instead, it is a strategic business decision that can swing the advantage in favor of the payers, especially in today’s competitive marketplace. By outsourcing the insurance claims processing services to a skilled and dedicated partner, payers can focus on improving core business operations and find innovative ways to increase customer satisfaction.

The MDI Advantage

At MDI NetworX, we have years of experience partnering with healthcare payers to tackle these specific challenges. Our suite of services includes advanced document imaging and data capture solutions that will reduce costs, minimize risks and improve efficiencies.

When you partner with us, you can expect:

  • Increased customer satisfaction
  • Improved quality and turnaround time
  • Increased efficiency

Reach out to us today to help us develop a customized solution to your unique needs. 


Latest Blogs

Utilizing AI/ML can improve claims processing efficiency & the provider-payer relationship

One of the biggest challenges that healthcare organizations continue to grapple with is the payer-provider disparities.

Learn more
5 Fail-Proof Tips for Optimizing Your Payers Operation Workflow

Understanding how to optimize operation workflows is pivotal in reducing wasteful spending and ensuring smooth workflow of the payer organization.

Learn more
Empowering US Healthcare Payers to streamline claims processing

MDI NetworX empowers business transformation by functioning as your trusted healthcare claims processing and adjudication service partner to streamline business processes.

Learn more