ClaimTECH Blog - MVA Claims Resolution & Beyond

Claims Management Software: Close the Provider-Payer Feedback Loop

Posted by ClaimTECH on Aug 9, 2017 8:23:50 AM

There’s a problem in the insurance industry. Delays in communication, multiple layers of 3rd party interest groups such as attorneys and insurance representatives, an
d inefficient workflows have been causing long, drawn out processes, partial payments, and market inefficiencies. Communication issues have especially driven wedges in what we call “the provider-payer feedback loop”. The provider-payer feedback loop is the continuous dialogue between insurance provider and payer to ensure a mutual beneficial outcome for both parties. Leveraging innovative claims management software will help to close those gaps and push an outdated industry to begin to adapt with modern technology.

By The Numbers

A recent article from Becker's Hospital Review shares the following data:

1. Forty-three percent of practice-based providers and 29 percent of facility-based providers experienced difficulty communicating with payers.

Providers can’t communicate effectively with payers. If you work in insurance or have ever had to file a claim, this isn’t new to you. How many times have you been called in the middle of a meeting at work, and been unable to return the call? Meanwhile, insurers have all experienced the feeling of leaving message after message on someone’s voicemail without being certain the message will ever even be heard. Claims management software will help close these clear communication gaps.

2.  Sixty-one percent of facility-based providers and 51 percent of practice-based providers said patient communication regarding health plan benefits and financial responsibility is a challenge.

Clear communication regarding health plan benefits and financial responsibility is the cornerstone of a functioning insurance system. If a patient is unsure of what they’re covered for or what they owe, there’s a clear gap in the system. Leveraging technology in the form of claims management systems will put clear lines of communication between all parties to ensure that there is no longer confusion on the side of the payer.

3. Seventy-six percent of payers and providers see administrative waste as a large contributor to communication gaps. Both parties listed redundant information requests, denied claims and inconsistent rules as top communication issues.

The status quo isn’t working. Waste in insurance is a product of an industry that is having a hard time moving into the 21st century. Redundant information requests, denied claims, and inconsistent rules drive huge costs in terms of both wasted time and additional costs. A smoother, more efficient process will also improve employee morale as employees see a more consistent set of rules as well as fewer redundancies in day-to-day operations.

4. More than 90 percent of providers and 68 percent of payers said phone communication remains the most common means of communication between parties.

Read that again. 90% of providers still use phone communication as their most common means of communication. While other industries are turning to online software to meet their needs and improve communication, the insurance and healthcare industries lags behind. This overreliance the telephone drives increased costs, slower claim processing time, and poor results for all parties involved.

5. Twenty-five percent of insurer respondents said online and multipayer portals would be their preferred means of provider communication. This is compared to 42 percent of facility-based providers and 35 percent of practice-based providers.  

People want claims management software. Online portals where you can login and view the status of your claim, communicate with different parties involved, and see the next steps in the claims process are the future of insurance. The number of people want to see the portal is growing, and we fully expect to see this number continue to rise year over year.

Claims Management Software

We believe that claims management software is the future of the insurance industry. Insurance technology, or “insurtech” for short, is driving innovation in an industry that’s “struggling to get more lean” according to RSA Canada. At ClaimTECH, we believe that in order to close the provider-payer feedback loop we need to attack the problem with solutions for both sides - carriers and payers.

Is Claims Management Software Right for Me?

Simply put, if you’re a provider or carrier, yes. At ClaimTech, we believe that new insurance industry technology is one of the 7 insurance industry trends to watch for. Whether provider or carrier, claims management software can help you through streamlined communication processes, improved savings across the board, and faster revenue cycles.

Here are some questions you can ask yourself while considering whether or not you need claims management software:

  1. Have I ever had a hard time receiving payments on time?
  2. Would I benefit from direct communication with insurance carriers rather than communicating through a 3rd party, like a law firm? (Read more about speeding up the process of MVA claims here).
  3. Would it be useful to have a portal in which I can monitor my claim status in real time?
  4. Is there currently a communication gap in the claims management process at my organization?

If you answered “yes” to any of these questions, claims management software may be right for you.

The Future of the Industry

Solving communication gaps between providers and payers is just one of many existing inefficiencies that will be solved with claims management software. As an article from Raconteur puts it, “Digital technology promises to transform the insurance industry with better deals and new policies for customers”. At ClaimTECH, we’re currently leveraging technology to settle claims faster, improve existing workflows, and drive more productive dialogue between providers payers. As a tech company working to transform an outdated industry, we will continue to update and improve our product as part of our growth over time. Insurtech is the future of insurance, and ClaimTECH is part of it. Check out our blog to read more about industry trends, the ClaimTECH platform, and more!

If you’re interested in seeing all of the benefits that ClaimTECH has to offer, request a call and demo from our team of claims resolution experts below.

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Topics: Insurance Carriers, Healthcare Providers