How Automation Improves the Healthcare Insurance Claims Process

We walk through how you can use automation in your healthcare insurance claims process to improve both the patient and employee experience.

When healthcare leaders decide to put automation into their team’s day-to-day workflows for the first time, we often hear their teams need convincing. What will it look like if a robot does employees’ jobs? Does that mean the robot is going to replace them completely?

We have good news for all involved. Implementing automation doesn’t mean your team is out of work – it means they’ll reap the benefits of easier processes with more accurate results that allow them to focus on the more important parts of their job.

Let’s take a closer look at how implementing automation solutions expedites the insurance claims process. We’ll delve into a use case in the healthcare industry that improves accuracy while boosting patient experience and employee satisfaction.

Reduce Human Error in Insurance Claims

The health insurance claims process has a lot of paperwork behind the scenes. At a basic level, Insurance Denial Specialists file claims, which companies often store in physical filing systems, for every patient who visits healthcare personnel. This process takes a lot of manual effort and time due to high patient traffic and volumes of manual data entry. Naturally, errors happen, leading to claims getting delayed or incorrectly denied. While there’s no way to totally eliminate human error, automation can considerably reduce its impact through standardization.

As part of an automation build, your claims process becomes standardized, meaning now there’s only “one” way of processing claims instead of many individual approaches. This automated process standardizes inputs and outputs, allowing for more robust error catching.

Let’s look at automating the claims denials resubmission workflow, including building a system of codes and flags. In the manual process, specific error codes for different claims routes denied claim back to a work queue. The appropriate party for reevaluation then reviews items in this claims denial work queue and attach additional needed documents to either the healthcare personnel or the patient.

Since this process tends to be relatively straightforward depending on the type of insurance claim denied, you can easily automate simple claims. In an automated version of the manual process indicated, based on the error code or claims denial code, the robot would either complete the process by gathering the required documents and sending them to the health insurance company or forwarding the unprocessed claim to an employee.

This automation of simple claims reduces the workload on the employees, allowing them to focus on more complex insurance claims denial cases. This automation of the decision-making process also increases both efficiency and accuracy.

Improve Patient Experience with Automation

While the claims process is of critical importance, its intricacies and reliance on manual decision-making and execution can take away the time your staff has for answering patients’ questions. When you free up your team’s time, focus and energy, they can better treat patients with specific attention to detail. This not only speeds up turnaround times but improves the patient experience.

Nobody enjoys receiving a claims denial notice. With fewer claims process errors, there will be fewer illegitimate claim denials, letting you eradicate confusion and frustration on the patients’ end. Of course, there will always be legitimate denials, and now you’ll have more time to focus on them.

Since your automation reduces the labor associated with resolving faulty claims denials, your business will also see lower costs. Unresolved insurance claims denials can wreak havoc on your bottom line. Automation can prevent the simplest errors that most often result in unresolved claims, mitigating the costs associated with clunky manual workflows. You’ll likely find you have more time, money and effort to put towards creating even more ways to improve the patient experience.

Automated Insurance Claims Improve Employee Satisfaction

We know by implementing automation to reduce the manual effort of claims processing, you reduce errors. But who was bearing the brunt of correcting those errors before? Your team members.

Reducing errors reduces employee stress and increases how quickly they can approve insurance claims. With automation, your employees’ day-to-day can become more enjoyable, which will help alleviate employee burnout in the long run.

Alleviating healthcare employee burnout is a nationwide priority. According to the U.S. Surgeon General, healthcare workers are negatively affected by burdensome administrative tasks that limit their time to focus on patients and colleagues. “The primary concern for burnout is not being able to emotionally take care of each patient individually or uniquely.”

Imagine the impact of reducing manual claims processing for your team. This is only one area of administrative work you can improve with automation, contributing to a renewed sense of purpose and connection for your healthcare professionals.

Now that your employees can focus on the processes and people that matter, they can also be more innovative. They can put more thought and effort into improving their own processes, making them more streamlined and robust. Employees contributing ideas for their own more efficient and reliable processes (automated or otherwise) helps foster a sense of teamwork and ownership.

Conclusion

If you are exploring digital transformation for your healthcare team and its processes, consider an automated insurance claims process as just one example of how automation can positively impact your team. Automation can simplify your work, reduce errors, expenses and burnout and open opportunities for further innovation. While you may have to do some convincing at first, with time, your team will experience first-hand the benefits of automation.