Health Plans Payer AI & Advanced Analytics: Open Claims Processing Cost Reduction & Automation

Описание: As a C-suite executive at a health plan, your strategic priorities include transformation of claims processing. It’s a challenge that similarly confronts your internal improvement teams and technology leads.

Processing health-plan claims often amounts to a lot of “invisible” information: You need timely answers to questions that are costing you profits:

• How many claims are open?
• What’s getting paid on time?
• How are individual examiners performing?

In this three-minute video from The Lab, you’ll see how we apply AI and advanced analytics to this pressing challenge. In fact, you’ll see a real business intelligence or “BI” dashboard of claims in action. At a glance, you’ll see, for any date-range you select:

• Total open claims
• Total processed claims
• Total unprocessed claims
• Average cycle time: Days open from date of receipt
• Average cycle time: Days open from date of service
• Total number of claims held in A/P status
• Volume of claims overdue tomorrow

C-level executives in healthcare insurance need filter-able information; The Lab delivers. And for every one you click, all of the supporting information updates in real time:

• Line-of-business: Commercial, Medicaid, Medicare
• Status code
• In network/out of network
• Health plan code
• More

In this video, you’ll clearly see the top types of claim status: Here, there are 12,000 for “Referral Required”—and more than 900 that are simply “Missing Information.”

But the advanced analytics and AI for insurance carriers, brokerages, and MGAs/MGUs only gets more powerful. You can easily get a historical view of claims—including how many were paid, average cycle times, on-time rate, paper vs. electronic submission, and much more. And all of this information is from the “single source of truth,” because it’s your data, from all your different systems, but standardized by The Lab.

In fact, we’ve spent the last three decades compiling and standardizing actual client engagement IP into our industry-leading Knowledge Base, where it’s been catalogued as rapidly re-deployable tools, templates, code, best practices, process maps, AI, automations, analytics, and more. We’ve even got a patent for our delivery methodology.

Finally, we’d be remiss if we didn’t call out the “killer detail” of this AI and advanced analytics for health plans and payers: You can see performance of claims processed by individual examiner. See the leaders… and the laggards. Ditto for IPAs and even individual providers within them! Get a handle on things like cycle times, and percentage of error-prone paper submissions.

We also know that busy healthcare executives don’t always have time to dive into dashboards… so we built a robotic process automation (RPA) bot which scours the essential information, and sends you weekly summary updates via email!

Learn more about how The Lab helps insurance businesses like yours:

https://thelabconsulting.com/industry...

All of our work is technology- and platform-agnostic. We use whatever systems you use. And we never outsource or offshore: all of our talent is right at our headquarters in Houston, Texas, in the good ol’ U.S. of A:

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Learn more about the Knowledge Base we’d mentioned above:

https://thelabconsulting.com/knowledg...

Schedule your demo with The Lab’s friendly experts today:

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