Insurance Claims & Bills Management Solution

Business Scenario

The client is a USA based healthcare insurance provider and claim processing house having 8 companies under their umbrella, each working independently towards providing services in US healthcare. The company specializes in providing software solutions in the area of claim management, medical bill review, policy administration, risk management.

Challenges

  • All processes related to bill review and claim management did not have a streamlined and maintained process flow.
  • This resulted in poor financial planning and dependencies in processing employees’ medical.
  • We worked as their technical arms for solution development, maintenance and customisation.

Solution highlights

  • The customised solution for risk managers and insurance companies offered an integrated approach towards claim management and policy administration on medical expenditure for different user groups
  • The system offers multiple bills and claims entry methods including EDI imports in multiple formats, traditional keyed inputs, image scanning, etc.
  • Online image and document storage for each bill and claim data processed
  • EMB Coded review explanations for each adjustment
  • One-click CMS reporting, retrieval, and correction for medicare
  • The system supports payment scheduling, reminders and alerts, and extensive claim notes for tracking integrity
  • EOR formats in printed, digital image, or digital transmission formats

Benefits

  • Improved and controlled bill review and claims management
  • Automatic and well-organized process flow
  • Better financial planning
  • Real-time repricing for the bill
  • Better checks and balances for payment approvals
  • Ease of access - digitalized document storage
  • Automatic Medicare submission