When an insured patient receives medical care, the services are billed to their insurance company. Medical providers, such as doctors' offices, submit the claim forms to the insurers. Some forms are submitted electronically. Others are submitted as paper documents.
Regardless of how the claims are received, insurance companies must process the claims information according to their guidelines in order to pay them correctly. After the claims are processed, the insurers can release the associated payments to the medical provider.
Many insurance companies use processing systems to adjudicate their claims. Here are a few important features that an effective claims processing system should include.
Paper claims require the insurance company to enter the submitted information into their system. This process can be time-consuming if human processors type all of the information manually. Additionally, the claims are more likely to include processing errors from items entered erroneously.
To help automate the processing of paper claims, a processing system should include optical character reader (OCR) capabilities. OCR helps convert scanned data into a digital format that the system can read. Thus, the paper claims information auto-fills into a processing program, just as an electronic submission does.
In most cases, human processors only have to verify the scanned entries, correcting any scanning errors instead of entering an entire claim.
The processing system should protect the health information of the patients denoted on the claims by limiting access to the system. Consequently, human processors should be required to log in to the system, blocking people without valid log-in identifications and passwords from viewing the health information that the system contains.
Additionally, passwords should only remain effective for a designated period before expiring. Processors should have to enter an updated password periodically, making a security breach of the system less likely.
Processing Speed Reports
To make it easier for managers to review the work of human processors in their departments, the system should include a way to track individual processing speeds. Based on a login ID, when queried, the system should provide a report of the number of claims that a human worker processed in an hour.
Tracking the processing speeds can help ensure that claims are processed in a timely manner. Additionally, it can help managers assist workers who may be falling short of company expectations.
To learn more about effective claims processing systems, contact a processing system vendor in your local area, such as Bill Accurate Inc., to schedule a consultation.