How Much Is Manual Claim Intervention Costing You?

Claims management is long and often complex and involves several manual tasks. These steps prolong the claims filing process and leave room for error. In addition, passing the claim between healthcare facilities, insurance, and billing systems extends the process further and causes unnecessary delays. Thankfully, there is a better way than manual claim intervention.

Learn how digitization transforms manual claim intervention and how you can save time and money through digital claim processing for your healthcare data management.

Key Takeaways:

• Manual claim intervention costs you valuable time and resources because of tedious tasks and high error rates.
• Auto-adjudication streamlines the claims process by reducing errors and making data available to all parties
• Hospitals and patients both save on costs when providers use auto-adjudication

What is Auto-Adjudication?

Claims adjudication is determining who pays what portion of an insurance claim. As claims come in, the insurance company follows steps to decide what percentage the patient is responsible for and what they will cover.

Auto-adjudication uses AI software to quickly review the claims for you. It looks for mistakes in the claim and identifies essential details and changes needed on the claim. As a result, it takes out the human intervention part of claim management, saving you hours and a significant amount of resources.

For auto-adjudication to work, you enter parameters that tell the system how you want to process claims and set rules to ensure it works quickly and efficiently.

What is Adjudication? The Five Steps in the Process of Claims Adjudication

10 Benefits of Replacing Manual Claim Intervention with Auto-Adjudication

Here are ten benefits you will see when you switch from manual claims intervention to auto-adjudication:

1. Improves the Efficiency of Data Input

When you eliminate paper from claims processing, you also improve the efficiency of inputting the required information. You no longer need to manually input the data from the claims forms into your processing system or databases.

Instead, it is safely stored in a master database where you can update the information in real-time with the most accurate information. This allows you to store and retrieve claims information more efficiently, which helps you process claims faster with fewer resources and personnel who would otherwise have to handle the manual tasks.

2. Streamlines the Payment Process

Auto-adjudication aligns everyone connected to a claim. As a result, the provider, patient, and billing organization have access to the same data, reducing miscommunication and streamlining the process.

Hospitals benefit from the streamlined process because they get paid faster, and employees making claims benefit because they have lower premium costs since the method is more cost-effective.

Image from Oracle

3. Reduces Claims Costs

Since healthcare premium costs are rising, employees are looking for ways to save them costs. Payers can save 10-20% when you digitize the claims process. In addition, you reduce operating costs by up to 30%.

Image from Oracle

4. Improves the Accuracy of Claims

Manual data entry has an error rate of 1%. These occur from poor handwriting, improper data entry methods, or misspellings. As a result, others reading the claim might not understand the original author’s intent or meaning when filling out the claim.

Auto-adjudication eliminates most errors as you can fill in all the fields  through a computer. They are then automatically added to your data system without having to retype the forms in every system, leaving room for more errors.

5. Results in a Positive Patient Experience

When you process claims faster and more accurately, you also improve patient satisfaction. They don’t have to deal with the headache of drawn-out processes and incorrect data. Instead, they can easily view their claims and billing information and receive quick updates if there are corrections.

6. Supports Claim Reprocessing

Insurance agencies deny about 30% of claims. Because most hospitals don’t have the knowledge or ability to preprocess claims, they don’t always refile those claims and regain the costs.

However, about 90% of claim denials are preventable. When providers are more involved in the processing and submission, claims are more accurately recorded, and all parties promptly manage denials.

Auto-adjudication connects providers and healthcare facilities to help manage claims and reduce denials.

7. Allows Online Access

The patients can access online forms and resources to aid them in completing and submitting claims. Online claim filing ensures the initial information is correctly entered and everyone else in the process has access to the original data instead of risking errors.

8. Collects Data in the Cloud

Once patients file their claims , you can store that data in the cloud to preserve its integrity. In addition, in the cloud, the data is updated in real-time as you don’t have to manually enter information when new data is available. Cloud storage also helps you easily share information between providers, billing organizations, and patients.

9. Provides Advanced Authorization

One of the benefits of automating your manual claims intervention is that you can also easily share that data with other systems. This is a crucial component of digitization because you can send billing or claims information between hospitals, insurance providers, and patients with minimal administrative costs or errors.

However, with the rise in digitization in healthcare also comes security risks. For example, in 2021, there were 713 major healthcare data breaches, up 7.5% from the previous year.

To share claims information securely, you need to use an automated system with advanced authorization features. These ensure that there are no data breaches and that only the designated recipient can see and adjust the claims.

10. Allows for Real-Time Updates

Most claims processing isn’t actually performing tasks but rather waiting. Billing has to wait for insurance to go over paperwork, and patients must wait for billing. If there are errors, all parties must wait even longer to receive an answer.

However, when you store the data in a cloud, everyone involved sees real-time updates so they can work with the most recent information, which reduces mistakes and improves efficiency in provider data management.

Calculate How Much You Can Save

Are you ready to streamline your processes and reduce errors from manual claim intervention?

Use our auto-adjudication savings calculator to discover how much you can save by digitizing your claim processing.

Contact us to learn more about our Coperor E-MDM platform for healthcare and life sciences.