Reduce costs and automate Insurance Claims Processing

Expert Opinion

Committed to serving their clients with high turnaround time, reliable and accurate information processing, insurance companies face in their claims departments challenges related to integration, process management and customer service quality. Processing paper-based claims is a time-consuming and complex process, especially when it comes to assembling the documents needed to process a claim. Several other factors also make this process more difficult:

• Time it takes to manually file and classify a paper claim, especially with continuously increasing volumes
• Difficulty in maintaining , filing and retrieving accurate beneficiary data
• Increased operational cost with the diversity of applications that manage claims-related data
• Different sources of documents, such as paper, email, electronic documents, images etc…
• The number of people involved in the claims process, both internally  and externally
• Difficulty in maintaining a high quality of work and timely response to customer inquiries (enhanced customer service)...

According to a survey conducted by AHIP (America’s Health Insurance Plans) that examined claim processing turnaround times, processing time greatly improved in the past years especially with the introduction of electronic claims and the automation of this process [2]. Even with an increase in number of electronic claims, the cost of processing a clean electronic claim was still nearly half the cost of processing clean paper claim.  Time to complete the processing of a claim was reduced from  30 - 60 days, to one to two weeks.  This was also accompanied with reduced administrative costs, enhanced employee efficiency and response time. It is now a fact; electronic claims are processed faster than paper claims. Sixty-nine percent of electronic claims are processed within 7 days; whereas only 29 percent of paper claims are processed within the first week. In addition, nearly 48 % of all claim files lack information needed to complete the operation, thus the claim is put on hold (pending) until the complete set of information is received and verified. On average pending claims require additional 9 days to process while more information is being sought. Claims are put on hold most of the times due to:

• The submission of duplicate claims (35 %)
• The lack of complete information or other information needed to justify the claim (12 %)
• Coverage issues (24%)
• Other or miscellaneous reasons (29 %)

New Case Management technologies for claims processing enable insurers to take a different, innovative approach speeding this entire process. These solutions provide claims adjusters with automatic document capture and field extraction from multiple sources and in various formats , in addition to automatic classification and categorization of the claim and its associated documents based on extracted metadata.  It also allows tasks to be automatically dispatched while tracking and monitoring employee performance. By implementing solutions for claims processing, insurance companies achieved over 90% accuracy in classifying documents, saving the efforts related to manually separate and join physical paper documents.  In addition to cost-reduction efficiencies, insurance companies were able to enhance their customers’ relationships with improved processing capabilities. Whether through customer self-service portal or internal staff handling a claim, finding the relevant information - part of the processing cycle or based on a customer inquiry - became easier as information was more readily and immediately available to people who needed it.

EVER TEAM the leader in integrated Enterprise Content Management Solutions provides EverSuite Case Management for Insurance Claims Automation, a rapid to deploy, easy to use and intuitive turnkey solution for claims management, processing and administration through a secure web interface.The solution allows insurers to cut claims processing costs, improve accuracy of paper claims adjudication, enhance productivity of claims examiners and archive paper claims for better and easier access. EverSuite Case Management for Claims processing provides the following benefits:

• Completely eliminate Paper Claims handling
• Reduce  Paper Claims Processing Costs by half, while seamlessly integrating with emails and outgoing documents
• Archive, search and easily find the required information, scanned claims and other relevant data  through a dedicated and easy to use interface
• Improve accuracy of paper Claims Adjudication and eliminate errors related to misfiled documents
• Improve compliance for audit trails and paper claims tracking 
• Reduce storage costs

Like all other EverSuite solutions, EverSuite Case Management for Claims automation provides an easy to use functional administration interface, allowing IT managers to easily set up and configure the application without writing a single line of code. The solution is also scalable, allowing insurance companies to add on to it additional modules or functionalities to meet their growing needs. Finally the solution is built on the latest technologies allowing easy integration with all IT environments including Microsoft SharePoint 2007 and 2010.

By Ziad WAKIM, VP Solutions, EVER TEAM

[1] Wikipedia.
[2] AHIP – Center for Policy and Research - Survey: Health Care Claims Receipt and Processing Times May 2006.