Using Claims Processing System For Timely Claims Settlement

The healthcare cost is rising day by day and it has become very difficult for the common people to meet the healthcare expenditure. More & more people are looking upon medical insurance to meet their urgent medical requirements. However, the problems associated with manual claims processing and settlement is discouraging people. It is believed that healthcare professionals spend their maximum time in handling medical claims, which otherwise could be utilized in providing timely & quality services to the patients.

Doctors are usually swamped under a mountain of insurance claim paperwork, confused by constantly changing insurance regulations and frustrated by long delays in payments and high claim rejections rates. To most doctors there seems no way out but to keep training staff, working long hours and hoping that the money comes in on time. In fact, a large no. of problems is associated with manual claims processing.

Doctors face significant difficulties with manual claims processing. Just processing paper claims is very costly. The complex network the paper claim goes through may result in long delays in payments of up to 90-120 days. The clerical personnel involved should be working on more important projects or providing higher quality patient care. On average 30% of paper claims are rejected due to errors.

In case of manual claims processing once these claims are rejected they are often just placed in a desk drawer and forgotten or could take up to another 120 days to get paid. Estimates from the American Health Care Administration (AHCA) state that the average cost of sending a paper claim could be as high as $15 or more per claim, other estimates put this much higher due to the high cost of administrative staff and benefits paid by the doctors.

Well, at last there is a light at the end of the tunnel and a way out of the never-ending cycle. That help comes in the form of electronic medical claims processing. Electronic claims processing seems to be the answer and it seems to be changing all this. There is no complex paper trail involving many people to follow. The claim simply goes from the doctor’s office to the claims specialist, then to a clearinghouse where it is forwarded to the insurance company. The whole process can be completed in less tha
24 hours involving just 3 or 4 people.

Insurance companies are saving millions of dollars every year thanks to electronic claims. The simplified processing steps and consequent reduction in error rate reduces the rejection rate from 30% or more to a mere 2% or less. The average cost per claim charged by the billing specialist is normally around $3 - $7, a large savings compared to an average $15 per claim. The electronic claims processing system ensures that the claims are being settled on an average of only 7-21 days.

Given these facts it's no wonder that doctors are converting to Electronic Claims Processing.