Automated Health Claims Management to Reduce Claims Leakage for a Leading Health Insurer
The Challenge
The customer had legacy IT infrastructure with multiple system integrations. Lack of validations during claims processing led to claims leakage. Manual processing of claims consumed more time. The customer was heavily dependent on TPAs for claims processing. Customer was seeking a system which could give them more control over the TPA and enable transparency. The customer wanted to bring in-house part of the claims processing.
The Solution – Automated Claims Processing to Reduce Claims Leakage
iNube implemented a system with flexibility for both TPA and Insurance company to process claims.
Exhaustive product configuration module to enable customer to introduce product offerings
Custom built workflows to incorporate TPAs using own system to upload data at strategic points during claims processing via a front-end interface (TPA Portal)
Capability to map Provider SOC and tariff against unique Service Codes was done to enable digital validation of claims
Business Rule Engine to flag duplicate claims, insufficient BSI, package mismatch etc.
ICD 10 based configuration of benefits, covers to enable auto adjudication of claims
Value Delivered
26%
Increase in auto adjudicated cases
32%
TAT reduction in Claims Processing
1500
Claims processed per month (Per day 50 claims)
17000+
In network hospitals are currently empanelled in the system
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