Health insurance claim denials cost payers and providers over US$300 billion every year. Other than the financial loss, both the payers and the providers incur additional administrative burden, increase A/R cycle, and loss of member goodwill. Take the example of providers who spend almost US$9 billion every year in appeal costs.
The key factors contributing to incorrect claims are similar across both the entities. Whether it is lack of uniform data collection standards, use of fragmented systems, lack of process optimization, or use of legacy platforms, both the payers and providers are struggling with analogous issues. The problem of claim denials is not unsolvable; however, payers and providers need to make strategic investments to address the issue. To know more about these investments, download the paper…
The viewpoint covers the entire denial management problem in detail, with specific focus on:
Key drivers of incorrect claims
How instances of incorrect claims can be reduced
The benefits of adopting a digitally transformative approach for the stakeholders
Case study explaining how an enterprise utilized a claim denial solution to improve accuracy while reducing claim processing time
