Essential Tools for Better TPA Claims Processing
With the rising costs of healthcare services and industry regulations, it’s no surprise why more organizations are choosing to follow a self-insured program. In fact, an article from the New York Times notes that companies with 300 to 400 employees are now the most dominant users of self-insured programs. Smaller companies are now looking to reduce healthcare costs by providing the benefit plans of their employees themselves. Which means that companies are breaking free from relying on insurance companies to cover the medical needs of their employees. And this is where the need for a reliable TPA claims processing software solution comes into play.
The role that insurance providers play for companies and employers shouldn’t be taken lightly. That’s why taking them out of the picture could be disastrous for any employer that’s looking to go for a self-insured program. For example, can you imagine how an engineering services company can handle claims processing or benefit plan management? Not likely, right? That's why self-insured companies would most likely need the aid of a third-party administrator (TPA) to handle all of it’s healthcare-related processes. In fact, the TPA claims processing software is one of the most essential support that any self-insured employer could get.
How Can Third-Party Administrators Provide the Best Service?
Third-party administrators (TPAs) help self-insured employers and organizations with their healthcare-related processes. For example, TPA claims processing is one of the most important services that employers need. But how exactly do TPAs ensure that they’re processing all the claims in the most efficient ways possible? With all the other organizations that offer administrative services, how does a TPA ensure its place in the market? A good place to start is by finding out if you have the best tools for the job. An article by the World Economic Forum (WEF) predicts that, in the year 2022, most organizations will be processing and storing 62 percent of their business data via computers. In other words, if you want to stay ahead in the game, you have to make sure that your organization is capable of processing most of its workflow with computers.
Additionally, as the article suggests, it’s inevitable for organizations to rely more heavily on technology as the years progress. As a result, the faster you enhance your technology, such as software and tools, the more chances you’ll have for a successful future.
The Best Software for TPA Claims Processing
With the need for advanced technologies and better processing capabilities, the primary features to consider are workflow automation and processing tools. This is especially true for organizations that handle healthcare workflows such as claims adjudication, electronic claims submission, benefit plans, provider contracting, and more. In fact, automation features can significantly improve your TPA claims processing. This is because software like QuickCap 7 can help you automate most of your claims workflow. Which means that you can process claims faster, more accurately, and reduce manual claim work. As a result, you’ll get a faster turnaround time for claims, you get less manual errors, and even reduce operational costs.
Aside from claims workflow automation, more advanced software like QuickCap 7 also offers more tools and features for your business. Which means that you won’t have to look for other software to handle other the workflows of your business. For example, an integrated management software like QuickCap 7 comes with features for electronic data interchange (EDI), authorization and referral processing, provider contracting, and more. This type of technology allows TPAs and other healthcare-related organizations to process most, if not all, of their transactions in one convenient system. You won’t have to worry about software integration anymore when you have all your EDI transactions, claims adjudications, electronic claims submission, and data management in a reliable management software.
QuickCap 7 for Faster TPA Claims Processing
With all the built-in features in QuickCap 7, you’ll surely improve your TPA claims processing as well as your other workflows. QuickCap has the following features to help you maximize your claims workflow:
- Auto-adjudication - fully automate your claims adjudication workflow with our advanced automation features. Simply configure the ideal rules and parameters for your claims adjudication and let the system do all the work so you can improve your adjudication accuracy, reduce manual workload, and allow your employees to focus more on technical claim reviews.
- Claim Submission - easily receive claims from different sources. We understand how different clients have different methods of submitting claims, that’s why QuickCap 7 is designed to handle numerous submission sources. Send and receive claims through EDI files, process scanned claims, and even submit claims directly into the system. With QuickCap 7, you can integrate any method of electronic claims submission that your clients require.
- Claim Dashboard - give your staff the ability to easily organize and manage all the claims that need to be processed. You can access the Claims Workflow dashboard where your teams can coordinate and review their claims in a touch of a button so you can make sure that you process all your claims on time.
As an advanced management software, QuickCap 7 is fully equipped with all the tools you need for your healthcare administration workflows. From EDI transactions, claims adjudication, provider contracting, and more, QuickCap 7 has the tools that your organization needs to succeed.
Reference:
- https://www.nytimes.com/2013/02/18/us/allure-of-self-insurance-draws-concern-over-costs.html
- http://www3.weforum.org/docs/WEF_Future_of_Jobs_2018.pdf
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