Third-Party Administrators
Boost your auto-adjudication rates!
Improve data quality in claims data and align provider, patient, billing org and service location data to maximize auto-adjudication.
GAINE CUSTOMERS VIRTUALLY ELIMINATE MANUAL INTERVENTION ARISING FROM BAD DATA IN CLAIMS.
Coperor E-MDM for Increased Profitability
How Does it Work?
Coperor E-MDM combines historical claims data with multiple other sources of provider, patient and contract data to build robust master profiles. These profiles combine with Coperor rules and machine learning capabilities to correct new claims before they are rejected and queued for manual review.
Business Benefits
- Experience dramatically increased auto-adjudication rates
- Minimize human interaction with the data
- Integrate third-party reference data sources in record time and with minimal errors
- Decrease manual claims processing time and overhead costs
- Greatly reduce IT intervention and solutions design for handling provider and member data issues
- Increase member and provider satisfaction with your claims processes
- Breathe easier – the systems are working together, finally, and scaling just got more reachable
Technical Benefits
- Deal with the complexity of multiple sources of claims data “sources of truth” across many systems
- Build an ongoing data governance process based on industry-standard rules modified by your best practices, custom rules
- Quickly stand up a solution with immediate results
- Establish a foundation for dynamic changes and growth in a fast-moving, regulatory-heavy business
- Fuzzy matching supported by machine learning to build alias lists and cross-walks
Streamlining Claims Processing: Setting a New Bar for Provider and Patient Data Accuracy for Third Party Administrators
This paper describes some of the key problems in medical claims processing encountered by TPAs, and how transformational organizations are implementing specific technologies to solve them and modernize claims processing workflows, increase automation, reduce costs, and increase profitability.
Enter Coperor Ecosystem MDM by Gaine
All data is validated against reference sources
All data is governed centrally and predictably in one place, synchronized across systems
The solution is scalable and data is highly accurate
How can your Auto-Adjudication Rates get the boost that they need?
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Understanding the Provider Data Management Lifecycle
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