Secure Healthcare Goals with Automated Claims Processing

A Quick Review on Automated Claims Processing

Managing claims can be a tedious process since each patient’s claim is unique. In response, healthcare leaders pushed for technological innovations that can configure ways to auto-adjudicate claim submissions. For this reason, automated claims processing has revolutionized insurance workflows by promptly determining eligibility assessments based on recorded patient data. This significantly reduces backlogs and improves care delivery in the long run.

Exploring Broader Capacities in Automating Processes

Automated claims processing has largely advanced healthcare productivity. It has also impacted value-based care delivery besides improvements in efficiency and speed. In fact, there are a few notable payoffs to automating the claims process, including:

Improved Patient Data Management

Care delivery entails a collection of transfers from one entity to another. Depending on the complexity of a case, a patient may require the care of specialists beyond their primary care physician (PCP). Patients may also undergo multiple medical procedures for more precise diagnoses.

Automated claims processing helps companies efficiently log all these tests and services through a coding system.  Using reference codes for each medical procedure, provider specialization, diagnosis, among others, which simplifies categorization during the billing process. This also ensures medical records follow a standard format, ultimately improving the record-keeping of medical histories. Having these structures in place means that tools for quality care assurance are readily available for providers and patients alike.

Valuable Contributions to Population Health Research

Automating claims procedures do more than just speed up billing processes. Insurance claims can also contribute to population health research since these records provide substantial patient data. Compared to theoretical control groups, claims data reflect real-world settings. The different variables can be studied methodically to yield valuable correlations on health demographics. In turn, the synthesis of collected data then contributes to the development of value-based care models for long-term application.

Reduced Ambiguity and Uncertainty 

In previous years, manual claims adjudication procedures have confused patients and providers. Aside from the time-consuming process, cases of missing data and inaccurate codes have stalled transactions, inconveniencing concerned parties in effect.

Automating claims processes can bridge these gaps in communication with improved data transparency. Companies can enhance the care experience to the last step of a patient’s journey by providing complete and updated information.

Execute Value-Based Care through Automated Systems

Claims processing is among the final phases of a patient’s journey, yet it is not an afterthought to care delivery. It has repercussions to more variables in the healthcare system. Having the right tools to optimize automated claims processing can improve response to greater patient and provider needs.

You can extend opportunities for value-based care delivery with QuickCap7 in your arsenal. The software goes beyond the promise of efficiency and accuracy with competent auto-adjudication workflows to assist you and your organization. Using data repositories to support claims management ensures that claim requirements are complete upon application. This saves patients and providers from exhausting resources as it curtails repetitive procedures. Maintain reliable workflows by keeping costs to a minimum and operations effective for long.

Choose the Support That Puts You and Your Patients First.

References:

1. Automated Claims Processing. “Automated Claims Processing.” Accessed December 20, 2022. https://www.managementstudyguide.com/automated-claims-processing.htm.

2.BN, V, A Sawant, C Shah, L Badgujar, and A Dang. “How Insurance Claim Data Can Help in Health Outcomes Research: An Indian Perspective.” Value in Health, November 1, 2015. https://www.valueinhealthjournal.com/article/S1098-3015(15)04864-0/abstract.