Claims Management
There are a number of external forces that are driving up the cost of healthcare every day which exacerbates the need for a comprehensive, efficient and accurate means to collect and analyze data related to both medical (UB-04 and HCFA-1500) and pharmacy claims. Measurement is the first step in understanding claims history and determining the effectiveness of programs designed to reduce healthcare claims. One of the key roles of organizations involved in the process of managing claims is the collection, processing and distribution of information for the purpose of reporting, analysis and decision making. For example, the ability to identify and influence costly “Out of Network” activities early on can have a significant impact on claims cost.
The days for managing by “gut feel” are over and there is call to action to put the technology and processes in place to enable fact-based decision making that can improve patient’s lives while increasing the efficiency of healthcare delivery.
OnApproach has the experience and the technology solutions to help healthcare associations turn data into information that can help their clients improve their analysis and decision making related to claims management.
SOLUTIONS
Claims Insight
Claims insight is a web based reporting solution designed for organizations that have a need to collect and analyze medical and pharmacy claims data. It provides the ability to securely access information about their patient population and all of the data related to their claims. As the need to bring in additional healthcare related data grows, Claims Insight’s modular architecture can accommodate additional subject areas (eg. Lab data).
Claims Insight takes the “raw” data provided by the payers and processes the data so that it can be easily manipulated by the user via such features as filtering, drill down, pivoting, export to other common formats, etc. making it possible for a user to spend 90% of their time on analyzing their data versus spending that time on report preparation.
Key benefits for users of Claims Insight are:
- Automated import of medical and pharmacy claims
- A single source of truth for all claims reporting
- An intuitive, secure interface
- Minimal upfront cost
- Scalability; other healthcare related subject areas can be added
- More time on analysis and decision making
Information on Demand