Claims management is generally defined as a process that requires the submission of all the documents related to patient hospitalization for the approval to achieve claims payment realization.
The claims management process varies widely and in most cases, is a manual process, relying heavily on physical documents and couriers.
- Physical paper file created for every claim
- Claim form filled manually
- Hand written form scan potentially hav elegibility issues
- Required documents put into the file based on human experience based knowledge
- Difficult to have traceability of status of claim
- Difficulty in having a centralised source of information for all transactions
- No visibility of approval status and payment status
- Searching physical documents to check completeness is a manual process requiring going through physical paper files
- Lots of Queries from payer due to incomplete or inaccurate information provided
- Extended cycles as a result of these queries
- All information already entered as part of preauthorisation auto filled
- Entire claim form and information electronically filled hence no legibility issues and reduced effort
- Soft copies of required document attached to claim.
- Reduced scanning as soft copies can be directly taken from HIS and attached
- Documents indexed for easy accessibility and reference
- Single window dashboard for the entire cashless operations of the hospital
- System configured to enforce mandatory fields and mandatory documents based on medical condition
- Reduced queries from payer for incomplete claims form and missing documents
- Clear visibility of current status of claim on the platform
- Significant reduction in payer queries hence potential improvement in TAT
- Payment status updates available on platform to direct real time visibility of claims approval and payment status
- Minimize claim rejections and resubmissions; deliver your claims to health insurers in real time
- Electronic Billing data for Process enhancement
- Conversion of Provider Bill data into IRDA Regulated Bill Coding Standards
- Expedite payer responses and boost your cash flow and free up time for revenue-enhancing functions, such as ensuring correct payment in claims process
- Improves the quality of process in payment realization to the health care providers
- Minimize the TAT of payer response time.