The Secret to Optimizing Automated Claim Payments

We are not going to waste any time with this one. Do you want to know the 1st secret to optimizing automated claim payments?

It’s Plan Building.

Plan Building is creating the benefit logic that will propel your TPA’s goal of increasing the auto-release of claims. Experienced Plan Builders can configure your Plan Logic and adjudication system to do two things: 

  1. Improve claim payment accuracy 
  2. Reduce overall claim administrative costs

Oftentimes, a TPA is faced with very quick ramp-up on new lines of business. With those new lines of business comes an influx of claim volume. If this is compounded by transitioning to a new claim platform, chaos is sure to ensue. New volume is beyond great, but the timing of it with other factors can be overwhelming and cause a lot of pain points for your team.

Plan Building can help minimize those pain points with:

  • Minimal impact to in-house training resources
  • Trained backup resources available in case of PTO
  • The ability to increase production on short notice
  • Reduced processing costs

You can accomplish this through review of the global system settings and code mapping. “Global mapping”, when well built, has the ability to facilitate automated selection of benefits against the right plan data. When mapping is not in place, ALL claims become a manual process which frustrates examiners. As a result, extended Turn Around Time is likely the source of many customer service complaints.

Plan Building is a complex skill that requires a high-level of understanding about the schedule of benefits, industry standard and reporting requirements.

JMS and Associates can help you to gain efficiencies for your claim processing through our proven skills in evaluating system mapping and Plan Building methodology. We are well-versed in a variety of platforms and can learn and adapt to those new to us. Our experienced resources are readily available to assist and become an extension of your Team.

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