Claims Management / Adjudication

Claims Management for Healthcare Payers solutions generally aimed at achieving complete automation of claims processing, faster access to customer information without compromising on the security of private medical information.

Automation helps in reducing costs associated with processing of claims, utilize a single platform for all data sources, workflows for routing claims for review and approval processes and increase the consistency and timeliness of payments. According to National Health Insurer Report Card, AMA, 2011, eliminating claims errors would save $17 billion annually.  Automation would reduce the paper storage and document retrieval costs while complying with regulatory standards like HIPAA.

Health insurance payers invest in their claims systems with the focus on interoperability and faster release of new products than just improving efficiency of claims processing. Systems should be flexible to create new benefit designs with ease, provide integrated health management and should have inherent flexibility and agility to adjust to the changing marketing conditions.

Business Challenges

  • Most insurance companies still use systems with complex steps and manual procedures, which results in an error-prone, inefficient structure with huge variations in performance.
  • Modernizing the systems to be compliant with HIPAA and other regulatory standards like ICD-9 / ICD-10 has been a major challenge.

Claim Evaluation Rules Engine functional flow

 Claim Management or Adjudication Functional Flow

Our Services

Nous has capabilities and domain expertize to convert existing systems with majorly manual intervention into an automation solution. These solutions would meet the best industry practices and thus allows interactions and integration with multiple external systems standardized and less cumbersome. With expertice in Data Analytics and appropriate use in modern systems, benefits can be multiplied.

  • Claim Management Automation
    We enable Automation of claims management process that provides faster access to accurate, up-to-date customer information to address customer inquiries quickly.
  • Claims Management Solutions in Insurance
    Integration of the claims management system with multiple other systems in the industry that helps improving operational performance and efficiency.
  • healthcare claims processing solutions Re-usable components and frameworks for claim processing and adjudication that quickens the application development initiatives.

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