Claims Data Entry
Health plans deal with large volumes of claims on a daily basis. Often times claims data needs to be scrubbed and entered into a format or system in order to quickly validate the information, adjudicate the claim against a schedule of benefits, and pay the correct provider.
At Sutherland, we are experts at the delicate task of indexing and processing claims data. Our mailroom and scanning facilities help to not only improve current data entry processes but also help health plans digitize their current data entry processes.
Pended Claims Resolution
The process of investigating and resolving a pended claim can be a complex and resource-intensive task. While there a pend reasons that are common to all health plan, the root cause of the pend can be unique to the health plan’s environment and, often times health plans do not have the resources to resolve and proactively prevent future pended claims issues through a root cause analysis.
At Sutherland, we process the backlog of pended claims health plans face. Most importantly, we then work closely with our clients to deploy proactive fixes so claims can avoid being pended in the first place and then work on ways to improve auto-adjudication rates. This helps health plans improve their turnaround times and decrease their claims operations costs.
The emphasis on managed care has created the need for health plans to reprice many standard codes to correspond with their focus on decreasing costs and improving quality of care. Unfortunately, because the reimbursement methodologies are so varied and can be incredibly complex, many health plans still struggle with the process of repricing their in-network and out-of-network provider contracts. In today’s rapidly value-based health era, it’s imperative for health plans to leverage proper claims repricing processes to ensure their claims are correctly adjusted and done so in a timely manner.
Sutherland helps health plans put in place processes that properly manage and reprice their claims. Our scalable and integrated solution helps health plans save costs and time by quickly obtaining health provider sign-off of negotiated discounts and minimizing turnaround and appeal times.
The adjudication of claims is one of the most important processes that a health plan performs. Unfortunately, many health plans are still bogged down by inefficient claims processes and outdated technology that makes the process slower and costlier than it should be.
Sutherland’s dedicated team of claims analysts and adjudicators support health plans throughout the entire claims adjudication process. We work with our clients to transform the process from receiving the medical claim, entering data, verifying key pieces of information, and then to processing the claim for payment. We speed up turnaround times through higher auto-adjudication rates and decrease overall claims operations costs.