Claims Processing

Automating Primary Claims Processing in an EHR has several advantages for healthcare providers, including improved accuracy and efficiency in claims processing. By automating this process, healthcare providers can reduce errors and increase productivity, allowing staff to focus on other essential tasks. Additionally, automated claims processing can help providers reduce the time it takes to receive reimbursement for services rendered, improving cash flow, and ultimately leading to better financial outcomes for the organization. Overall, implementing an automated Primary Claims Processing system can streamline operations, reduce administrative burdens, and ultimately improve patient care and products for the organization.

Claims processing is undergoing a seismic shift due to automation. For example, did you know that McKinsey predicts that by 2025, 25%of insurance and healthcare industry processes will be powered by artificial intelligence, revolutionizing how the industry operates?

Claims processing can help solve one of healthcare providers’ biggest challenges - denied claims. For example, one study found that nearly seven in 10 healthcare providers experienced a jump in denials in 2021.

It's important to note that the exact steps a bot might take can vary depending on the specific electronic prescribing and medication management software and the healthcare provider's workflows. Additionally, while the bot can perform many of the medication management tasks, some actions may require human intervention and oversight, especially in complex cases.

Function:

Insurance Filing

Revenue Cycle Management

Claims Filing

Steps

Data Extraction: The bot may extract the necessary data from the EHR system, including patient information, diagnosis codes, procedure codes, and insurance information.
Verification: The bot may verify that the patient's insurance is active and that the services provided are covered under the patient's insurance plan.
Coding: The bot may assign the appropriate diagnosis and procedure codes to the claim based on the patient's medical record and the services provided.
Adjudication: The bot may submit the claim to the appropriate insurance carrier and track its status throughout the adjudication process.
Payment Processing: Once the claim is approved, the bot may generate a payment request to the insurance carrier and record the payment in the EHR system.
Denial Handling: If the claim is denied, the bot may generate an appeal request and resubmit the claim or take other appropriate actions to address the denial.
Reporting: The bot may generate reports on claims processing metrics, such as the number of claims submitted, the percentage of claims approved or denied, and the average payment time. These reports can help healthcare providers identify areas for improvement and optimize their claims processing workflows.

Popular Applications

Our services are not limited to these applications. This automation is available for any cloud based application.