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Medical Claims Departments Are Struggling to Keep Up

    Jun 23

    Ian Campbell
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    For health insurance payers and third-party administrators, processing paper medical claims is an inefficient waste of people, time and money. Scan those paper claims, extract and validate every field of data and upload a clean EDI file to your claims management system. Get 99.97% accuracy via AI and machine learning with human intervention for the data that falls below a certain confidence threshold. Automation, and creation of a dependable 837 file for your CMS, is the way to go for a better, faster member experience at a lower transaction cost for your company.

    Most claims departments today are struggling under the weight of heavy operational expenses, inconsistent delivery, an elevated level of fraudulent claims, and increasing customer expectations. 

    The tight labor market has made it difficult for payers to meet the challenges facing their teams with human talent. Using a digital workforce to capture and process medical claims forms automatically (UB-82, CMS-1500) in paper form and convert the data into 837 format data files is helping many payers meet the demand.

    Claims processing is critical to the financial health of any payer and to your relationship with the healthcare services organizations that submit claims to you. Payers are using robotic process automation (RPA) and claims processing automation to maintain a high level of service while facing today's challenges.

    Key facts about claims processing automation

    • These files can be passed to your claims management system or to a data clearinghouse.
    • Data from the paper claims is extracted using a combination of optical character recognition, artificial intelligence software and human intervention
    • Original claims images can be retained for future audit or random QC purposes
    • Guarantee 99.97% accuracy of data
    • Paper claims can be scanned by you or DTI can scan and convert claims as your outsourced partner. Paper claims are mailed to a PO lockbox, picked up, sorted, scanned, data extracted, validated and returned to you in a 837 data file within 48 hours via secure FTP.

    Digital transformation for payers

    In addition to automating claims processing, payers are transforming their back office processes in a number of other ways including taking advantage of virtual mailroom services where DTI receives your mail, scans it, and sends the scanned enveloped and contents to the appropriate person, implementing cloud-based workflow tools that give you better visibility into employee productivity and pinch points. In an era of hybrid remote & in-office environments, services like these are especially valuable.

    Next steps

    To get a free assessment of how claims automation can benefit your healthcare organization, schedule a call with Keith or just give him a ring at (714) 396-7080.

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    Posted by Ian Campbell
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