Insurance Claims
Process Claims Faster, Cheaper and more Accurately
To realize profitability and provide quality member services, it is critical that health insurance companies reduce costs while also improving productivity and service timeliness. Claims management is a key business function that insurance companies can focus on to achieve these requirements.
For example, it typically takes more than an hour on the phone for providers and customers to receive status on their claims – simply because payers lack the visibility to track and monitor the activities involved with processing. Iterations of claims correction and re-submission make matters even worse. Manual, disjointed activities make it difficult for payers to instantly trace activities and status, which also increases cycle time, lowers productivity, and adds to the overall cost of processing.
- Ensure HIPAA compliance with high-speed transaction validation
- Improve partner performance with partner-specific performance reporting and detailed error messages that provide the information needed to correct mistakes
- Reduce phone calls by exposing reports and transactions to your partners through a secure, web-based provider portal
- Enable error correction with on-screen, form-based transaction view, correction and immediate re-submission
- Be informed of processing problems with configurable proactive alerts for you and your partners
Reduce Fraud and Abuse
Hundreds of billions of dollars in insurance claim fraud and abuse plague today's healthcare environment. TIBCO systems can identify fraud as it's happening – rather than after the fact – enabling healthcare organizations to reduce abuse with a significant impact on operational efficiencies and the bottom line.
TIBCO enables your business to process more claims faster with less fraud, while leveraging existing resources. TIBCO's platform automates processes, provides real-time visibility into the status of claims, and meets regulatory compliance mandates, while empowering healthcare organizations to:
- Improve productivity: Process millions of transactions per day
- Increase profitability: From reduced processing costs
- Deliver more timely services: Improve satisfaction with real-time activity monitoring
- Minimize mistakes: Mitigate risks by reducing painful iterations of correction and re-submission
