The drumbeat to drive down healthcare costs will only grow louder in 2017, as payers and providers continue to search for ways to drive out inefficiency, eliminate errors, and introduce more automated solutions. We believe that this focus will finally lead them to more fully embrace auto-adjudication in a meaningful way, especially for non-acute procedures, which tend to be consistent, repeatable, and the same amount from patient to patient.
Auto-adjudication uses software to encode business rules and processes that can be applied to review claims and render decisions on whether to reimburse or deny claims, without the need for manual review. The ultimate goal being a clean claim that gets processed automatically after the first submission without the need to contact the provider to request more information.
When done well, auto-adjudication reduces claims processing costs, decreases clearing times, and allows integration of real-time fraud detection and recovering services. While the benefits seem compelling, payers have been slow to adopt as they have traditionally been financially incentivized to hold on to insurance premium dollars as long as possible.
A claim requiring human intervention costs approximately $4 to process, while an auto-adjudicated claim costs approximately $1.
- Alsbridge, Inc.
The tipping point is here for auto adjudication in 2017. Read more about the final prediction in our white paper.
Tags: Health Innovation, Healthcare consumerism, Healthcare predictions