About sixty two percent (62%) of the claims presented by providers to payers could be completely processesed electronically.
As it now stands, it takes human intervention for the entire adjudication process: checking member eligibility; authorization services; and arranging payment--a huge drain on dollars, manpower and time.
most claims adjudicating could be automated with card services technology, but just try to find another card product that knows how...
The endemic fragmentation of the healthcare industry has created a business opportunity of epic proportions. Industry expenditures are in excess of $1.1 trillion, and yet, there is no significant automated payment and auto-adjudication system in use. Given the state of technology, the healthcare system is years behind in the use of payments and information systems.
Imagine the credit card system if it consisted of clerks making telephone calls to verify credit cards and relying on hard copy documentation. This is the relative state of the healthcare system due to the fragmentation of the industry.
Fragmentation has created costs in terms of inconvenience and inefficiency. Fragmentation exists in the payers' systems. Because of this, providers, always resistant to change, have been discouraged from embracing new payment and reporting technologies since they would require the use of multiple systems and added administrative costs. The market is ripe for a system that provides a common basis for both providers and payers.
Allegis Technologies currently possesses a single system that synthesizes and combines information from both areas to create a process for auto-adjudication of healthcare claims that require no human intervention. Over sixty percent (>60%) of the claims submitted to payers by providers of care are for fifteen specific service codes (CPT codes) and are adjudicated based upon a simple set of rules that can be used to automate the payment of these claims.
These rules include testing to ensure that the patient is actually eligible for care on the date of service, the contracting status of the individual provider submitting the claim, deductible and copayment status. These claims represent seventeen percent (17%) of the total payments made. Automating the adjudication and payment process will save significant costs currently inherent to the payer's cost structure.
To find out more about bringing the auto-adjudicating revolution to your company, contact the experts at Allegis Technologies for a free consultation and demonstration.