Top 3 Reasons for Backlog with Claims

No one likes a clog. Webster defines this word as “to crowd excessively, especially so that movement is impeded”. It brings to mind images of clogged toilets, clogged arteries, and clogged roadways. … All of these are bad. All of them imply pain and now with a trickle-down effect with pain later in other parts of the body or system.

Sound familiar? If you’re a Third-Party Administrator, it likely does. These scenarios are just like a clog in your claims department. A backlog of claims is painful now, and what some realize (yet many do not) is that today’s backlog in Claims started in the Mailroom and eventually turned into today’s backlog of Claims, which will be tomorrow’s backlog in auditing and customer service. It’s a cycle that does not stop until you deal with the whole system. First the dreaded clog and then all the upstream and downstream processes. You get the point. 

Here are three reasons why a backlog typically occurs.

  1. Multiple examiners go out on leave at the same time.
  2. New business. A new group comes in and brings with it a large volume of claims.
  3. A Conversion! Going from one claims platform to another, changing accustomed efficiencies for volume output.

Backlogs develop quickly and volumes easily get out of control. Some take months to resolve. However, by recognizing these potential “clogs” in advance many of these challenges are preventable or minimized with appropriate planning. 

Given time, JMS and Associates can work with you to put a comprehensive solution in place. We are here to help implement an improved workflow that is more practical and efficient for your business.  JMS can be used as an extension of your team with our experienced resources readily available to assist.  Our claim examiners can easily adapt to your platform and business rules to make those claims disappear.

One important thing to remember? It’s not magic, its proper evaluation, planning and resourcing and seeing into the future. So maybe we are a little bit magic. 

Interested in a partner? Learn more about our capabilities and contact a sales representative to discuss the right package for your needs.