The two major issues in the heavily regulated health claim industry are service and costs. The health insurance industry is required by law to service their customers. Claims must be paid or denied within regulated time frames. When claims are not processed within those time limits, expensive penalties are invoked.
Exterprise aims to remove the service inefficiencies inherent to paper files that generate costs and expensive regulatory penalties by means of their Web-based document repository and automated claims workflow solutions.
Process your HCFA, UB-92, ADA Claims on a 12 / 24 / 48 / 72 hour schedule
Handle entire process from mailroom, to scanning, to data conversion.
That helps in managing the payment of claims within regulated timeframes
Proven Double Key data entry methodology and relationship validation of the data.
Digital images of the Claims are available for research on a Client’s in-house imaging system.
A full complement of production reports to assist the Client manage the process.
Exterprise’s web-based, electronic document repositories and automated workflow systems together help in reduces costs, assure compliance, and increase overall service levels. Most importantly, it reduces the cost of re-submission of claims.
The Web, document management, and workflow systems present new opportunities for insurers to increase service levels, manage claims processes, and eliminate costs.
Web access dramatically reduces costs because it encourages self-service. Web-enabled document management systems give simultaneous access to documents and claims status information to providers, claims reps. and claimants. When documents are held in an electronic repository, service levels increase because claim files are never lost and documents are never misplaced. The need to request a duplicate claim submission is eliminated.
Costs are eliminated as the workflow takes over unnecessary manual tasks. The automated workflow manages the payment of claims within the regulated timeframes, thereby avoiding expensive penalties for non-compliance. As the workflow guides complex claims from department to department, it automatically gathers information for proof-of-compliance. This results in out-of-the-box compliance reporting and near real-time dashboards.