Modernize Your Claims Adjudication System: A Buyers Guide
Select the right solution to streamline workflows, increase adjudication accuracy, and improve payer-provider collaboration.
- High claim hold volumes 鈥� driven by outdated adjudication systems 鈥� are often caused by coding errors, incomplete documentation, or missing data. These issues trigger manual intervention and delayed reimbursement.
- Reliance on manual claims processing leads to time-consuming workflows, increased errors, and operational inefficiencies, diverting resources away from patient care.
- Disparate healthcare IT systems create inefficiencies and data silos, requiring significant investments to enable seamless integration and improve claims management 鈥� hence the need for modernization.
Our Advice
Critical Insight
- The significant financial investment and need for skilled personnel required to modernize legacy claims systems can be prohibitive, especially for health plans with tight budgets.
- The challenge of ensuring seamless interoperability between legacy and modern systems can lead to operational disruptions, making CIOs hesitant to pursue system upgrades.
- Modernizing claims adjudication systems carries risks such as downtime, data migration challenges, and workflow disruptions, potentially impacting claims processing efficiency.
Impact and Result
- Identify the market trends of claims adjudication systems and business benefits.
- Determine the business needs and key capabilities of modern claim adjudication systems.
- Analyze system features and vendors in the market to help achieve desired outcomes.
- Leverage Info-Tech鈥檚 Health Insurance Claims Adjudication Evaluation and Scoring Tool to get started.
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- Anonymous CIO, Medicare & Retirement, Insurance Solutions, Health Insurance Company in Eastern US