Healthcare Claims Management with Claim Adjudication

Reduced Claims Processing Time with Digital Health Claims Management Solution for a Health Insurer

The Challenge

The customer was experiencing a growth phase and wanted to scale up their systems. Their existing core system had limited functionalities. The current application lacked workflow for role wise claim processing based on financial limits. Provider management, SOC validation, TAT monitoring case management and investigation was being handled manually​. In other words, there was an explicit need for an automated health insurance claims management system.

The Solution

iNube decided to leverage its existing product ClaimsLive Health, for Health Insurance Claims Management, to meet the requirements of the Customer.​

  • End to End Claim adjudication process from intimation to settlement ​
  • Front end to configure business rules to enable automation of claims adjudication​
  • Exhaustive Case Management module to configure medical protocols and drug & implant masters to identity any deviations from standard line of treatment​​
  • Suspect cases could be flagged assigned for further investigation either to an internal investigation or external agencies​
  • Workflow to handle investigation cases via integrated health claims investigation mobile app​

Value Delivered

  • Reduced manual activities​ ​
  • Replaced physical file processing and digitized all activities​
  • Exhaustive Case Management module to configure medical protocols and drug & implant masters to identity any deviations from standard line of treatment​​
  • Customer recognized for the ‘Best Claims Service Provider of the Year’ at Insurance India Summit & Awards 2018​

12000

Average Number of Claims Processed Per Month

21000+

Health Claims Investigations Completed

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