Saving Time and Money on Insurance Claims With Benefit Verification Automation

Many healthcare providers are all too familiar with the processes and difficulties of making claims with health insurance. In fact, these complications end up costing around $30 to $71 dollars a claim, summing to around $262 billion in insurance denials annually. A major factor contributing to this loss is that nearly 65% of denied claims are never reworked, even though two-thirds of these claims are recoverable.

But what causes this large proportion of claims to be denied? Typically, it’s the method of capturing the insurance information in the first place. The tried-and-true paper and clipboard method requires manual labor and yields an error rate of 4.2%. Digital intake has a smaller error rate, but takes as much as 5 hours per workweek, or 260 hours annually, or tedious labor. New Optical Character Recognition (OCR) technology is promising, however its novelty means it has a low 60% percent rate.

Building vs Buying an Insurance Capture System

The best alternative is to have your own health insurance capture and verification system, either by building your own or partnering with a dedicated insurance verification business. The former entails a hefty upfront cost. You need anywhere from $1M to $5M just to design, build, test, and implement the systems. Then, you need to maintain it. An IT team is required for the updating and troubleshooting of the system. Therefore, you have to pay the team to be there, pay to train them, and pay for the repairs they need to make.

This only covers the physical aspects though. The OCR, HL7, RPA, Conversational AI, and other web services require technical knowledge to operate. Then, there are costs associated with making the system regulatory compliant and securely encrypting data to prevent a cybersecurity breach. You also need time to train the AI, time to retrain the AI whenever updates happen, and high costs over the lifetime of the system.

Alternatively, you can partner with a company that already has these insurance capture and verification systems in place. With this method, you don’t have to have a dedicated team or have to pay the upfront costs of developing your own systems. Unfortunately, you lose the uniqueness, customizability, and proprietary nature of building your own systems. You also stake your own company’s insurance needs on the reputation of another company.

Conclusion

Insurance capture and benefit verification automation helps to bridge the gap between making your own system and leasing another. It validates, verifies, and maps payer and plan data in 5 seconds or less. It can accept printed ID cards, online wallets, screenshots, referral letters, and more. Ultimately, regardless of your reasons, taking advantage of these systems is the best way to take care of your health insurance claim needs.