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Healthcare Claims Solutions

Healthcare ClaimsHealth insurance companies recognize the necessity of improving their ability to manage and control their claims processing models as a key component of their overall competitive advantage. These companies have found that projects targeted at reducing administrative costs such as online customer self-service and electronic claims processing can help provide significant financial and customer service advantages. Traditionally, the nature of claims processing has been a labor-intensive, rules-based operation, further complicated by compliance to governance and regulatory initiatives, state and federal legislation.

Overall, the cost of U.S. health care administration totaled $394.3 billion in 2004according to a recent study. The overhead of public and private insurance in 2004 represented 5.9 percent of the total health care expenditures in the U.S. or $76.0 billion. Among selected major U.S. private health insurance companies, the number of employees per 10,000 enrollees ranged from 13.7 to 35.1. Reducing administrative spending was one of the main objectives of the turnaround strategy of one of the major providers. In the last two years, the company cut $600 million as a result of technology improvements.

A key source of this improvement was the companies ability to auto-adjudicate 70 percent of its claims. For some health insurance companies, outsourcing claims processing in one form or another reduces overall administrative costs and achieves economies of scale. In the last several years, major providers have all outsourced portions of their claims processing to health care outsource providers that deliver peaklevel processing capabilities with predictable accuracy and turnaround times.

The mere act of paying a claim faster improves relationships with doctors and hospitals, provides more timely data for actuarial analysis and lowers administrative costs. To reduce the cost of operations, DIT can transform and integrate business functions across the enterprise by combining content, process and connectivity within a single integrated solution. Examples of the content supported by DIT Solutions include paper documents such as a claim or any correspondence, internally or externally developed forms, emails, electronic documents such as Word documents and Excel spreadsheets, XML, and audio or video. Process or what the industry refers to as Business Process Management (BPM) extends beyond workflow. Not only automating the work processes, BPM also gives health insurance companies the ability to model, simulate, analyze, report and collect production data so executives can continuously assess the production environment and, more importantly, adjust work processes as business conditions require. Connectivity is the Enterprise Application Integration component that allows the solution to integrate with other internal or external applications, allowing data to be both pulled and pushed from these other applications. The ability to gather all information can enable the right decisions to be made faster and accurately.

To reduce the cost of operations, DIT Solutions can transform and integrate business functions across the enterprise by combining content, process and connectivity within a single integrated solution. Examples of the content supported by DIT Solutions include paper documents such as a claim or any correspondence, internally or externally developed forms, emails, electronic documents such as Word documents and Excel spreadsheets, XML, and audio or video. Process or what the industry refers to as Business Process Management (BPM) extends beyond workflow. Not only automating the work processes, BPM also gives health insurance companies the ability to model, simulate, analyze, report and collect production data so executives can continuously assess the production environment and, more importantly, adjust work processes as business conditions require.

 

More Information
Contact DIT
714.529.7600
Dit info@dit-solutions
Resources
Web Based Document Hosting Overview
Claims Overview Presentation
Claims Adjudication Services
Off-Shore Services Presentation
Understanding Six Sigma

Dit Solutions