Claims Processing

Claims Processing

REASONS FOR THE SYSTEM INITIATIVE
Claims processing involves easy steps to be accomplished like entering data, categorizing and reviewing them on the side of health maintenance organizations (HMO). But when such transaction is multiplied to hundreds and thousands of different cases, the supposedly simple processing becomes a very complicated procedure if done manually.

By being heavily paper-based in processing claims, even recording and copying information are already highly prone to errors such as typographical ones. Paper documents are also difficult to manage as they can get lost, misplaced and damaged easily. With the tedious and critical steps involved, the turnaround time that is tied to incentives is risked to a slower and delayed processing as well. These inefficiencies with inaccurate information kept then limit insurers in making better decisions and in delivering their responsibilities.

RECOGNIZING AN INNOVATIVE STRATEGY TO PROCESS CLAIMS
As various challenges and consequences are discovered from the manual practice of processing claims, Claims Processing by Infobuilder is offered as the new tool to revolutionize the current unproductive method. This is also to help insurers manage and
process health benefit claims faster and easier. From filing, assigning of control number, processing, reviewing, and to the paying of claims, all these steps are simplified with the use of the system.

When the medical forms related to claims are received from hospitals, these documents are easily captured by scanning them. As they are scanned, data are extracted intelligently, and managed and stored effectively through an organized platform and repository. The
solution can also serve multiple clients as form templates and terms used by different hospitals can be created, added and updated. Because of this, the identification and categorization of claims are automatically done to save time and effort.

Claims Processing system is also empowered with an automatic document routing capability to specific users or performers for them to accomplish their tasks on time. The performers include the scanners, extractors, processors, checkers, and MA reviewers.
Records management and retention policies are also applied as documents on claims are processed. While granular data are kept accurately, the system is then able to generate more comprehensive reports that provide summaries and analytics.

BEYOND EXPECTATIONS
Designed to streamline the processing of claims, this highly scalable solution by Infobuilder offers a set of benefits that can surely overcome the challenges being experienced which includes the following:

  • Faster processing and turnaround time
  • Reduced processing errors and costs
  • Improved delivery of service to partners and customers
  • Enhanced productivity and accuracy
  • Easier claim and document categorization and review
  • Automatic routing of documents to target authorized users
  • Robust flexibility to different medical terms and forms
  • Competent generation of useful reports with summaries and analytical data
  • Effective application of records management and retention policies
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