Bill Gates once said, “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.”

Applying strategic technologies to insurance claim follow-up activities, Bill's statement holds true. Used correctly, technologies can increase efficiency by ensuring that the right claims are touched at the right time.

Consider the scenario of working to resolve a large volume of claims; the most time-consuming component of the workflow is checking the status of each claim via individual payer websites. Representatives rely heavily on accessing payer websites, and they make time consuming phone calls to secure the current status of outstanding claims.

This manual process can add 5-10 minutes per claim just to identify the existing status.

If this unproductive time were to be spent actually working the claim to move it forward to resolution, productivity would improve, more claims would be adjudicated, and payments from payers presumably would increase. Well... MediRevv recently went "hands off" by implementing an ‘auto claim status’ solution that saves time and increases efficiency within our insurance A/R follow up efforts.

How The AUTO CLAIMS STATUS SOLUTION works

Data scraping is a technique that is not industry specific. Put simply, a computer program extracts data and converts it to a human-readable form. Our auto claims status verison of this technology typically returns a more comprehensive data set, including line item information, additional detailed denial messaging and payment information. The interface with data scraping offers more flexibility than previous solutions, including 24-hour scheduling and customizable rules-based status retrieval that supports the provider’s revenue cycle needs.

The most recent claim status as reflected on the payer website is automatically displayed in the follow-up representative's work queue when an invoice is accessed. It shows the current payer status of the claim (claim paid, claim denied, claim in process, no claim on file, etc.) which will prompt the representative on what step to take next toward claim resolution.

Benefits of the auto claim status solution

• Insurance payers welcome data collection interfacing technology because there is no charge to payers and it greatly reduces calls to their customer service centers.

• Follow-up representatives are quickly able to access the status information all in one place, rather than spending time collecting data on each individual payer website or make a lengthy phone call to secure the information.

• The claims that need a human touch are quickly recognizable and completed, whereas claims that are under normal processing or adjudicated for payment will no longer require action by representatives.

• There is an immediate efficiency gain achieved by limiting manual effort in data collection in repetitive processes that provide no value, and representatives are able to work claims at the right time for best results.

• The data is integrated with MediRevv’s myQ insurance follow-up driving technology, and is available for upload into the client’s host system for transparency and performance reporting.

• The implementation process is streamlined and requires minimal effort to put into production compared with other technologies. That means it is not a drain on already overextended IT resources.

• While HIPAA EDI 277 Claim Status Response information is limited in the information provided and many responses from a 277 file are generic in nature, auto claim status typically returns more complete and comprehensive data like the specific reasons for claim denial.

The Bottom Line

Finding ways to save time and increase efficiency through technology solutions remains a high priority for every healthcare organization. MediRevv has partnered with GAFFEY Healthcare to use this technology-driven, web-based data collection technology, which interfaces with insurance payers to decrease the manual effort of reviewing payer websites. If your organization is interested in magnifying efficiency in insurance claims follow-up, MediRevv is happy to assist.