Deliver enhanced efficiency, accuracy, and speed to casualty claims processes
For insurance carriers, rising healthcare costs are creating challenges and complicating regulatory compliance. For auto insurance carriers in particular, medical expenses reported by claimants have increased faster than the rate of inflation, according to the Insurance Research Council (IRC). And the average submitted medical bills continue to rise across both bodily injury and Personal Injury Protection/MedPay.
It's vital for insurance carriers to reduce delays in workflow and optimize productivity to reduce dissatisfaction among clients, contain medical inflation and control costs.
Workflows, processes key to optimal outcomes
Casualty claims processes are complex even under normal market conditions. And with new, ever-changing market pressures at play, many organizations lack the capacity to dial in new technology and reimagine workflows that can save time and money. The failure to modernize is creating measurable pain for these organizations. Auto insurance carriers that resist new technology and modern processes are losing their competitive edge and market share.
Automation key to cost-savings, efficiency
Claims automation can provide relief to these complicated pain points. According to a Deloitte study, automation could free between 54 million to 285 million adjuster hours annually, amounting to potential cost savings between $1.7 billion and $8.9 billion, within five to seven years, depending upon their level of investment. For auto claims organizations facing medical inflation and difficult market conditions, automation provides powerful outcomes, including:
- Improved document intake processes: Through automation, auto claims organizations can efficiently receive, scan, data capture, index, and direct claims mail and other artifacts to the right resources, reducing delays. Artificial intelligence (AI) and optical character recognition (OCR) technologies with business rules can automate document classification and data capture, creating standardized digital versions of claims documents.
- Enhanced regulatory compliance: Auto claims organizations must align with business rules and regulatory compliance. For medical bill review, most payers partner with companies that provide software and services to deliver automated comparisons of billed charges to regulatory fee schedules, provider network contracts, utilization review decisions, and more. They can then generate an EOR that informs providers of the rationale for any reductions applied to the billed charges. These processes keep regulatory requirements in check while enhancing accuracy and ensuring standards.
- Streamlined, frictionless integration: Unlike manual processes, automation allows systems, people, and processes to work together. An integrated adjuster portal can augment claim systems with tools that streamline the adjuster’s medical bill adjudication steps. An effective bill review platform will automate the identification of bills that require an adjuster’s input and present them to the adjuster in a user-friendly portal with contextual information for fast, effective decisions. Having the right information at their fingertips supports adjusters in making effective and efficient decisions related to compensable medical services and medical reserves.
- Reduced customer service inquiries: A highly automated medical bill review process utilizes technology at every point in the process — from bill intake to payment — accurately and efficiently. A high-quality medical bill review platform that includes an eBilling clearinghouse, digital mailroom, and electronic payment solutions can reduce delays, duplicated billings, and provider inquiries.
Partner for progress
Conduent helps first-party auto insurers manage claims efficiently and accurately so they can deliver exceptional care to their customers.
Our Strataware® medical bill review platform ensures that charges are compensable and compliant, matching payment recommendations to stated policy limits while confirming that payment recommendations accurately reflect deductibles, copays, and policy limits. When combined with our digital mailroom, eBilling clearinghouse, Shield Adjuster Portal, Shield Provider Portal, and +Pay payment processing services, auto insurers can maximize medical cost savings, efficiency, and speed to payment by automating many of the steps in the process.
The Strataware platform can be used as either a licensed software model or as an outsourced bill review service solution.
Together, we can make your business thrive with the highest level of automation for medical bill management and workflow efficiency.
Ready to drive high-performing claims processes while containing costs and offsetting medical inflation? Visit us online to learn more or schedule a meeting.