Reduce the Cost of Processing Healthcare Claims through Automation Technology

The December 2014 “State of the Payor” industry survey compiled responses from over 120 leaders from health plans across the United States. They found that over 88% of those surveyed are currently using or plan to use technology as the catalyst to transform their organization this year.

More than 87% stated that stricter requirements resulting from the ACA was the major contributing factor in their decision to participate in new healthcare delivery models. In addition to the ACA’s Operating Rules, the 2011 Medical Loss Ratio (MLR) mandate requires that 80% or 85% of every premium dollar must be spent on medical care and healthcare quality improvement, which leaves only 15-20% of revenue to pay for administrative costs. If these limits are not met, payers must issue rebates to their members. This requirement pressures health plans to do more with less.

How are insurers reducing administrative costs? According to the survey, 86.55% are planning to automate their manual business processes to help reduce administrative costs and 60.5% said that increasing auto-adjudication rates would lower the cost of processing claims. To that end, nearly half of respondents said they were planning to invest in new claims processing technology in 2015. That would help drive down the $6 to $9+ per claim manual processing cost cited by two-thirds of surveyed insurers.

Increasing automated claims adjudication can be a challenge for many healthcare payers, but HCIM’s SymKey® is the perfect Virtual Claims Processor for the job. SymKey® works 24×7, is 6-8x faster than its human counterpart, is accurate and consistent, a team player and a very quick learner. SymKey® has an immediate impact on reducing the cost of claims processing. Here’s an employer reference from the IPA Administrator at Choice Medical Group:

“SymKey’s an asset to our team and is really an ideal employee because it’s incredibly efficient, always does what it’s told, never calls in sick, and won’t ever quit on us. SymKey® has allowed us to automate a high volume of claims so our processors can focus on higher priorities and more complex tasks.”

If you’re interested in utilizing automation technology to lower your claims processing costs, call 888-454-0202, option 5 or email sales@hcim.com.

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About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.