How payers can speed up the claims process

A strong provider relationship is key to effective data sharing

The slow claims processing cycle impacts payers in a major way. Because it can take more than a month for an organization to report a member's hospital visit, payers don't receive instant medical records that help identify high-risk patients.  

As of late, payers realize that timely access to data is a must, and the pressure is on for them to implement strategies to make this a reality, reported Healthcare IT News.

For instance, the Medicare Advantage star rating system urges payers to adopt more patient-centric approaches, such as greater access to clinical data, reducing adverse reactions and decreasing repeated tests and scans, noted the article.

This is easier said than done, suggested the article. For starters, even though clinical data is available from various providers, payers may not have systems in place that can accurately sort the data. Additionally, a payer's IT system may run on different platforms, making it difficult to align with a provider's IT system.

However, it is possible to overcome these challenges, noted the article. Listed below are three suggestions for payers:

  • Establish a phase-wise approach. This begins with core system integration--treating medical claims first as the structure of the phase system--and ending with non-standard data sources, which allows organizations to adopt more powerful intelligence by leveraging large amounts of non-standard data sources as types of consumer-driven data.
  • Create a master patient index. This will allow payers to pull in data from different lab and pharmacy systems to aggregate and normalize the information.
  • Aggregate the data. This will help payers not only view a member's entire medical history but also allow them to identify the high-risk members.

What's more, establishing a strong payer-provider relationship can ensure more efficient data-sharing. And because payers have a vast amount of data enabling them to create risk models, perform financial analytics and better understand which members need what services, sharing that information is tremendously valuable for providers.

For more:
- here's the Healthcare IT News article

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