Is your organization still manually processing claims? According to the CAQH Index, on average, manual transactions cost $4.40 more than electronic ones. By switching to electronic claims, providers can save more than $15 on every single medical claim.1 For example, billing staff must process different claims for each of the hundreds of different insurance plans and they are printing out copies and manually hand-keying information into their claims adjudication systems. This process is not only time-consuming, but it can cost your organization thousands of dollars in rejected claims.
But what if there was a better way? By leveraging the latest advancements in technology, organizations of all sizes are looking to replace inefficient manual tasks with automation that intelligently brings order to an otherwise chaotic situation. Read on as we dive into detail.
How Does it Work?
How can automation help? Let’s explore the technology and then look at an example of how Intelligent Automation (IA) can be used to save your organization time and money.
Import faxes, emails, and other digital documents or use scanning software such as PaperVision® Capture to turn incoming paper claims into digital files.
Once the files are digital, PaperVision® Forms Magic technology leverages its patented Artificial Intelligence (AI) engine to automatically extract data from the claims to eliminate manual data entry.
Data is then validated against the claims adjudication software. The PaperVision® Automation Manager leverages Robotic Process Automation (RPA) tools to find and lookup missing information to ensure the claim is complete and the data is formatted correctly allowing staff to focus on more important tasks.
After the claims are validated the data is then exported. You can leverage the optional Business Rules in PaperVision Capture to export the claims in a variety of formats, including HIPAA 837P EDI ANSI for adjudication.
Ensure claim data remains secure while in transmission and at rest with Enterprise Content Management (ECM) software, such as ImageSilo® or PaperVision® Enterprise, to help you comply with the Health Insurance Portability and Accountability Act (HIPAA) and other federal regulations.
Claims Processing At Work
For example, claims arrive in a variety of formats such as a fax, email, and paper. Once the claim is received, AI technology is then used to extract the data on the claim. Once the data is extracted, the unattended robots get to work processing the claim. The robot can then find and lookup missing information to ensure the claim is complete and the data is formatted correctly. If the robot can determine that the claim is valid, the robot updates the status and exports the data to an external claims adjudication system. If for some reason, the robot cannot find missing information or cannot confirm the claim is valid, all data gathered is sent to a person to work on as an exception process. The employee uses attended robots to interact with external systems to complete the exception task to finish processing the claim. The claim data is then securely stored in the ECM system to help ensure compliance with HIPAA and other federal regulations.
How Much Could You Save?
30% of healthcare spending goes to waste and $190 billion is spent on administrative paperwork alone.2
On average, manual transactions require five minutes more than electronic ones. Providers can save almost 40 minutes per claim by switching to electronic claims. 1 – CAQH Index
By the end of 2018, payers that implemented Robotic Process Automation (RPA) will have saved $1 billion globally.3 – IDC
With statistics like these, there’s no question you need to bring automation to your process today! Contact us today for a FREE demo and find out how much you could be saving.
“In 2017, out of the $3 trillion in medical claims submitted by hospitals, around 9% of charges were initially denied. That comes out to $262 billion in potential loss for the hospitals. Even though 63% of those claims were recoverable, it cost them $8.6 billion in appeals-related administrative costs.”
1 CAQH Index – https://www.caqh.org/about/newsletter/2018/10-takeaways-latest-caqh-index-report
2 The Balance – https://www.thebalance.com/healthcare-costs-3306068
3 IDC – https://www.the-digital-insurer.com/wp-content/uploads/2018/03/1129-IDC-FutureScape.pdf
3 Change Healthcare – https://www.healthcarefinancenews.com/news/change-healthcare-analysis-shows-262-million-medical-claims-initially-denied-meaning-billions