Top 3 Claims Management Tips for Health Payers

claims management
February 24, 2017

Posted by MedbillingExperts / 0 Comment

Health payers often face a lot of criticism from various quarters of the society for reasons ranging from lack of transparency in their operations, delays in reimbursements and rejections of claims. The only way they can overcome this situation is by streamlining the various aspects of their claim management process. Here is a list of tips that will help health payers to be successful in this endeavor.

1. Keep the client in the loop

People too often feel like that they are deliberately kept in the dark regarding their claims. The only information they get their hands on is the acceptance or denial letter of their request. As a result of this there is a lot of grievance and apprehension about the happenings in the industry. In such a situation, the only way healthcare payers can alleviate the likelihood of complaints and score big on customer satisfaction, is by making patients a part of the process and keeping them in the loop at all times. The best way to start is by including patients and policyholders in interactions relating to claims, thereby creating a win-win situation for all the concerned parties.

2. Maintain clean and updated records

Health payers need accurate information to make sure that reimbursements reach the right person and at the right time. If the records are out-of-date or lack critical data, these groups could struggle to complete the action. Hence it is important for them to start cleaning and updating records by implementing following actions:

  • Remove duplicate contacts
  • Merge information whenever and wherever possible
  • Inspect segmented lists for errors

3. Understand different billing models

With the shift from fee-for-service to value-based care gaining momentum, it is become extremely crucial for health payers to understand the different billing models such as centralized, decentralized, hybrid and outsourced medical billing to achieve success in claims management.

Rather than being caught up between fights regarding how actions are billed, this understanding helps them to focus on delivering better patient and customer care, and complete the claims management process without any lag time.

The Bottom-line

Health payers need accurate information to decide on whether to accept or decline a claim. By keeping data clean, making the client a part of the process and having a first-hand understanding of various billing methods, these organizations can ensure a smooth sailing.

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