Claims Processing (for Healthcare)
Claims Processing Solutions increase efficiency, profitability
Even though about 80 percent of incoming health claims are electronic, the remaining 20 percent are typically paper-based, presenting a health insurer with high volumes and high costs. OnBase Claims Processing Solutions helps reduce costs in this area by 15 to 30 percent.
By integrating with core claims applications, OnBase is able to verify if coverage is in place and if the policy is active before distributing a claim to an assigned adjudicator. With OnBase's Advance Capture capabilities, claims forms may be identified and classified (automatically noting any duplicate claims), extracting line item data from claims forms such as UB04 and CMS1500, and converting the values to an XML data stream. This can then be imported directly into core applications to create an EDI file, eliminating costly data entry, improving process quality and reducing processing times. With the OnBase Claims Processing Solution, insurers have identified the ability to significantly reduce headcount by more than 50 percent in data entry areas.