Auto Adjudication:
Processing Claims with Ease

We should also take note that competitive prices and medical claims processing are key factors in customer retention. Therefore, customers stay longer if payer organizations can reduce costs and streamline their claims processing.

Processing Claims with Auto Adjudication Systems

Our current technological advancements are opening options for payer organizations to mitigate claims processing costs. For instance, we've reached an innovative junction between manually or auto adjudication of claims.

Manual Adjudication

As the name suggests, manual adjudication requires staff or employees to manually enter and review the insurance claims. Although computer systems are still utilized to enter and process the claims, this method is not as fast and accurate as fully automating your claims adjudication processes.

Auto-Adjudication

With auto-adjudication technology, a computer system can enter, review, calculate, and process the medical claims with zero to minimal human interference. You simply define certain rules and parameters to configure how the system processes the claims. So with auto-adjudication, you get faster medical claims processing time, more accurate adjudications, and less manual work. With benefits and ease of automation technology, more payer organizations are starting to invest more in auto-adjudication systems.

Why automate your claims adjudication process?

Since processing claims is a central part of a payer organization’s interests, by simplifying processes and minimizing costs, automation plays a crucial role for success. When you invest in auto-adjudication systems for your claims, your organization can optimize current processes and keep up with the rising demands of the healthcare industry.

According to a study from the World Economic Forum (WEF), by the year 2022, 62 percent of an organization’s data storage and data processes will be executed via computers. So with the rising trend of automation technology, investing in auto-adjudication systems can definitely help your organization stay relevant in the near future.

A higher adjudication rate means a higher rate for success

An article by Healthcare Finance News states that the best rate for auto-adjudication would be above 85 percent. So if payers can adjudicate 85 percent of their claims without any manual intervention, their efficiency rate becomes very ideal for success. Remember, your adjudication rate determines your success, so you need the best auto-adjudication system to optimize your claims processes.

Getting the best auto adjudication system for your company

The main problem with medical claims processing falls in the accuracy of the information that is provided. These days, most medical or insurance claims are sent electronically through electronic data interchange (EDI) channels, which are analyzed and adjudicated by software systems.

But as good as most systems are, they’re still prone to problems like security breaches, fraud, inaccurate data, and miscalculations. So getting an auto-adjudication system isn’t enough. If you want to secure your company’s success, you need to get the top and one of the best automation system available in the market.

Like QuickCap’s auto-adjudication features, you need a system that’s advanced enough to accommodate different claim EDI formats, secure enough to prevent fraud, and accurate enough to validate crucial details and calculations.

QuickCap 7 is the auto-adjudication system that you need

When the benefits of automation is only limited to the capabilities of your technology, you shouldn’t leave the quality of your automation to chance. Your system should automate medical or insurance claims adjudication processing without a hitch. 

QuickCap’s rule-based auto-adjudication feature allows payers to do the following;

• Increase security by minimizing the rate of fraud or invalid claims through flagging features.
• Processes claims from different formats like EDI files, scanned claims, and more.
• Accommodate different EDI file formats through configurable trading partner parameters.
• Validate eligibility requirements and authorize medical services accurately through rule-based configurations.
• Calculate payments for copays and deductibles instantly and accurately.
  

QuickCap can also help you streamline your administrative and clinical processes;

• Customizable Dashboard - personalize your dashboard and control every aspect of your workflow with our user-friendly task management system.
• Workflow Automation - maximize productivity when you automate claims adjudication, authorization verification, and referral management processes.
• Data Analytics - make secure and calculated decisions with our reliable risk stratification and predictive analytics tools.

To compete with the constant demands of the healthcare industry, it’s important for healthcare payer organizations to invest in faster and more reliable data processing tools for their daily operations. 

Automate your administrative and clinical processes using QuickCap v7.0 so you can streamline your workflow, reduce costs, improve customer experience, and ultimately secure your organization’s growth.