Can Medical Claims Processing Be Faster and Smoother?

by | Jan 9, 2023 | Healthcare

A medical claims processing form and stethoscope lie on a desk

Medical claims processing is one of the top challenges of medical companies and insurance providers. Many systems are outdated, introduce avoidable errors, and cause unnecessary delays. In addition, data is changing faster than providers can manually update systems.

There is a better way to perform medical claims processing that can avoid these common delays and errors. By adopting these updated and streamlined processes, your company will receive payment sooner, and patients will receive more accurate invoices.

Learn how to combat common challenges in the medical billing claims process to build a smooth and efficient process.

Key Takeaways:
  • Medical claims still use outdated and manual systems that cause avoidable delays.
  • Use automation and technology to gather, store, and manage patient data.
  • Digital processes improve the accuracy and speed of medical claims processing.

What Is Slowing Down the Medical Claims Processing?

The steps in processing a claim include:

  • Adjudication: Checking a patient’s eligibility and insurance
  • Explanation of benefits: Sending the results of the claim and what’s covered
  • Settlement: Finalizing who is responsible for what amount

Prompt pay laws require insurance companies to complete claims within a set time, averaging around 30 days. However, delays due to inaccuracies, manual tasks, and miscommunication can cause that process to take longer. The claim may undergo multiple rejections until it’s correct and reaches settlement.

According to 69% of healthcare leaders, medical claim denials have increased over the past few years. As a result, medical companies need streamlined and more accurate data processing.


69% of healthcare leaders say denials have increased
Image Source: MGMA

8 Tips to Speed up Medical Claims Processing

These eight tips will help you avoid delays and issues during claims processing to improve your medical billing process.

1. Clarify the Billing System

A set billing process increases the efficiency of claims processing. When you have an established process, everyone knows what steps happen next and their role in claims processing. That way, the claim keeps moving forward instead of sitting stagnant because no one is sure who will take the next action.

Keeping patients informed about their role is also crucial to a seamless claims process. Patients are not as familiar with claims processing as medical businesses and insurance companies. Therefore, they might not know what paperwork to fill out or what information to provide.

Educating patients and providing billing information ensures patients are informed and provide the information required for processing their claims accurately.

2. Maintain Accurate Patient Data

Data inaccuracies are a common reason for billing claim delays or denials. For example, a treatment facility’s name on file might not match the insurance company’s name. Patients also change their information during treatment or immediately after, which can cause delays.

Keeping your data accurate, including updating addresses, names, and health information if needed, is key to a fast and efficient claims processing process. You will also want to double-check with third-party providers to ensure they also update their systems with any patient changes.

Regularly scrub your data to identify errors, missing information, and duplicate data to keep your data as accurate as possible. Using an electronic health record also improves data accuracy by creating a single source of truth for all providers and insurance agents involved in a patient’s journey.


3. Use Automation

Artificial intelligence and automation speed up claims processing and reduces errors. Much of the claims process involves data entry and other tedious, time-consuming manual tasks. Performing these functions by hand slows down the entire process. In addition, manually entering claims data risks introducing errors.

When you incorporate automation into your process, your employees have more time to work directly with patients and function in core business roles. You can also process claims faster as the software automatically inserts information and checks for errors.


How businesses use AI
Image Source: McKinsey

4. Incorporate Electronic Claims Processing

Paper claims and invoices are more common than electronic processing. However, snail mail is outdated and prone to avoidable delays.

Switching paper invoices and forms for electronic claims processing allows you to send claims instantaneously to the appropriate parties. As a result, patients receive the bills sooner and can make convenient online payments to close the claims process.

5. Thoroughly Review Claims

On average, 80% of medical bills have errors. Manual reviews sometimes aren’t enough to catch all the potential mistakes that cause delays or denials.

Medical companies use claim scrubbing to scan for errors to ensure seamless claims processing. Taking the extra time to check for errors will save time overall since you won’t deal with as many denied or delayed claims.

6. Regularly Submit Claims

Claims build up quickly, so when businesses wait to send claims out at the end of the week, they can cause delays.

Medical companies should send claims daily to increase the speed of claims processes. That way, they stay on top of the claims, and insurance companies are not overloaded. 

Filing the claims faster also ensures correct information. Waiting to file claims might mean the information on the claim is outdated.

7. Monitor Claims

Claim processes should not be a series of siloed functions. If you keep each step separate, you won’t fully understand where the claim is and what is causing delays. Tracking claims through its entire process helps you find those small areas you can streamline or places you introduce errors.

Setting up notifications allows you to quickly address issues when they arise. For example, you might set a deadline for processing payments. Then, if you don’t receive a payment from the insurance company in that timeframe, you can contact them to find out what the issue is.

8. Continually Train your Staff

Medical claims processing is constantly changing. Each insurance company has unique requirements, and the government is introducing laws to help manage medical billing.

Regularly training your staff keeps them informed to correctly process medical claims. In addition, updating handbooks and resources with new laws and regulations will avoid mistakes and miscommunication.


Streamline Your Medical Claims Processing

Gaine’s Coperor One solution connects healthcare providers, insurance plans, and third-party administrators to move medical claims through each step effortlessly. The platform also creates a single source of patient data to ensure accuracy during the claims process.

You can store, validate, and manage all patient data through the system while adhering to the latest privacy regulations.

Contact us to learn more about the Coperor One platform to improve the efficiency of your claims processing.


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