4 ways to streamline your healthcare claims processing workflow with automation

Healthcare claims processing workflows are some of the most difficult for insurance companies. On top of complying with stringent regulations and assessing the validity of claims, there’s the added pressure that some of this work has life-and-death stakes.

The challenges are complicated by the fact that workers are prone to error, especially when completing repetitive and mundane tasks in healthcare claim processing workflows. According to 2020 research by the Centers for Medicare and Medicaid services, Medicare had an average 6.27% error rate for claims processing, to the tune of $25.74 billion in improper payments.

Controlling these spiraling costs is one reason automation is essential for insurers.

The technology minimizes potential for human error, improves overall accuracy, reduces labor costs, speeds up claim processing times, and even improves customer experience. To enjoy these benefits, insurance companies simply need to restructure their operations.

How to automate your healthcare claims processing workflow

The entire claims processing workflow is easy to break down into five steps that can be automated.

1. Digitize health records and forms

Fully digitizing documents is the most efficient way to streamline data management and speed up claims processing. All paper forms will eventually get input into an electronic database, so organizations should seek to eliminate them wherever possible. This alone saves countless hours on manual data entry.

Intelligent document processing (IDP) solutions can use AI to quickly recognize and categorize information on every claim document, helping workers process each one more quickly. Additionally, for organizations that can’t completely eliminate paper, optical character recognition (OCR) technology can quickly convert scanned files into editable text to eliminate much cumbersome data entry.

2. Verifying Identity and insurance

The first step of any healthcare claims processing workflow is verifying that it’s for an existing customer. Without automation technology, workers have to review each claim form and manually search for patient names, policy numbers, and other identifying information in their database.

Intelligent document processing solutions integrate with any database for ultrafast validation. AI can match patient names on documents to customer information in their database without the need for manual review. The programs also automatically flag errors or information inconsistent with their database.

When workers only have to review issues instead of every single submitted claim form, processing time speeds up drastically, shortening turnaround time and increasing customer satisfaction.

3. Managing online claims

With digitized medical records and claims, it’s easy to distribute information wherever it needs to go. Workers can access each record in the database and perform the tasks that fall under their role, from initial claim intake and investigation to final payment disbursement. Once they complete their work, intelligent document processing systems can notify the next employee in the workflow.

Eliminating paper from these processes saves time and effort and minimizes the potential for information leaks. Plus, users can also program IDP systems to follow HIPAA regulations around how information is stored and shared.

4. Update claim status in real time

Digital recordkeeping doesn’t just streamline communication between claims processing personnel — it can improve communication with customers as well. In the same way IDP systems push notifications to workers, they can share status information in real time with online portals, so both patients and providers can log in to see if a claim has been paid yet. All of this information auto-populates on online portals, saving both customers and insurance providers the hassle of phone calls or emails requesting updates.

Healthcare claims processing workflows are some of the most complicated in the insurance industry, but automation helps make them more manageable. In the increasingly competitive marketplace, it’s the best way to improve accuracy and profitability. Implementing the technology isn’t just a win for the insurance company but also for customers who benefit from faster processing times and more accessible status updates.