State of the Payor Industry Survey Indicates Need for Business Process Automation

More than 130 leaders from health plans across the United States responded to HealthEdge’s Jan. 2014 “State of the Payor” industry survey. As a company that offers business process automation solutions, we were particularly interested in question #4 (below), which shows that 81.3% of surveyed payors believe it would significantly reduce their administrative costs to “automate existing business processes” and 55.5% believed it would help to “increase auto-adjudication rates.”

HCIM’s SymKey application streamlines business processes by automating manual workflows and increasing auto-adjudication within your existing claims system. And with a go-live in less than three days, it’s certainly quicker to implement and more cost-effective than transitioning to a new core claims transaction system. For more information or to request a risk-free 30-day trial, click here.

4. Which of the following factors do you feel would have a significant impact on reducing administrative costs at your organization? Please check all that apply.
Answer Options Response Percent
Automate existing manual business processes 81.3%
Increase auto-adjudication rates 55.5%
Outsource/BPO 12.5%
My organization does not need to reduce administrative costs 10.9%
Other 6.3%

 

7. What percentage of your claims are currently adjudicated automatically?
Answer Options Response Percent
Less than 60% 26.1%
Between 60% and 70% 14.3%
Between 70% and 80% 21%
Between 80% and 90% 25.2%
Greater than 90% 13.4%

 

8. What is the approximate cost of adjudicating a claim manually at your organization?
Answer Options Response Percent
Less than $6 per claim 38.7%
Approximately $6 per claim 14.3%
Approximately $7 per claim 13.4%
Approximately $8 per claim 16.8%
Approximately $9 per claim 4.2%
Greater than $9 per claim 12.6%

 

To request the full results or learn more information about the survey, please visit http://www.healthedge.com/resources/state-of-the-payor-industry-survey.

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.