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Improving health claims processes has a significant impact on the business of insurers. Efficient claims management helps insurers improve customer experience, reduce processing costs & time, adjudication errors, and increase regulatory compliance.
Datamatics Business Process Management (BPM) solution for healthcare helps insurers and payers transform their claims management processes. Its insurance clients have reaped significant benefits in terms of cost, speed, and accuracy by using TruBot, an enterprise grade multi-skilled robotic process automation (RPA) bot. Datamatics uses advanced imaging technologies, document capture, proprietary intelligent document processing solution, TruCap+, and rule-based algorithms to mine context and intelligence from unstructured data. This helps insurers minimize adjudication errors, reduce claims processing costs, increase efficiency, and deliver a superior customer service experience.
Datamatics BPM solution for healthcare enables enterprises to take full control and cognizance of monitoring and eliminating fraud in the claims processing. It engages Artificial Intelligence (AI) / Machine Learning (ML) algorithms and reduces instances of false positives and false negatives while improving the processing time and turnaround time.
Years of Experience
Expertise in delivering intelligent solutions for the healthcare and insurance enterprises in both international and domestic markets
Claims Processed Annually
Delivered automation projects using point solutions as well as end to end automation models across geographical barriers
Images Processed Annually
Precision deliveries to ensure statutory compliance in a timely manner
Audit trails with high visibility and traceability
Engages intelligent document processing and RPA to expedite scanning and processing of paper-based forms
Provides exceptional processing speed and accuracy catering to all payer requirements
Offers claims registration, claims verification, claims settlement & disbursement, fraudulent claims management and audit of claims management
Accelerates claim settlement procedures
Adjudicate claims forms with minimal errors. and high levels of accuracy
Reduce instances of false positives and false negatives with AI / ML algorithms
Facilitates faster settlements and lowers healthcare costs per claim
Ensures cost reductions in data processing and ensured savings year on year
Ensures accuracy in payments processing
Facilitates direct payment to account
Offers effective contract management, sales automation, quote and rate underwriting, risk classification, and pricing solutions
Offers interactive web portals to enhance member-provider engagement and interaction
Offers a digital ecosystem to expedite claim processing and settlement
Ensures complete automation of the data management system to facilitate new membership enrollment, renewals, eligibility checks, monitoring, and client billing
Presents user friendly, Omni-channel care management that helps payers provide on-demand support to patients
Facilitates a seamless transition from the traditional ‘‘Fee for Service (FSS)’ payment model to a more integrated ‘Pay for Performance’ model, with automated coding and insurance verification
Covers posting of payments received from Health insurance payers / members towards settlement of claims to relevant patient accounts
Maintains updated records of patient information and related contact details
Facilitates updating of interactions in the patient, payer, and provider ecosystem
Offers all patient communication on a single platform; automates the hospital's precision care workflows and guides the patient with real-time data access.
Provides services and software for quality management, regulatory compliance, and F&A management
Offers auditable and enterprise grade solutions
A payer is the organization that evaluates the risk and decides the premium payment amount for the insured patient, collects the premiums, evaluates the patient’s claims, processes them, and pays out for the claims for a healthcare or medical service the patient has received. For example, insurance provider company
A provider is the entity or facility that delivers the healthcare or medical service. For example, hospital, doctor’s clinic, nursing home, etc.
The Healthcare Process Management digital platform allows to automate the end-to-end claims processing. It allows to process the different medical claim forms, digitize them, and classify them. It further extracts information from both the structured and unstructured forms with intelligent Document Processing or Intelligent Data Capture, auto-validates the data as per pre-defined logic and business rules, and incorporates the information in the core systems. A cloud-based distributed architecture allows to collaborate across distributed geographies, thus improving the scope and reach of the process. The claims adjudication is a part of the claims process that evaluates the claim information, decides the final payout, and generates a remittance slip along with the reasons for short payment. The digital platform finally credits the approved amount to the insured’s account. The end-to-end digital claims processing is executed within a fraction of the time required for manual claims processing.
A digital Healthcare Process Management platform expedites processes of the payer or insurance provider services, such as adjudication. It is powered by Advanced Analytics & AI/ML. It allows to speed-up claim evaluation, weed out uncovered charges, offer reasons for payment denials for specific costs, generate remittance advice, etc. Simply put, the digital Healthcare Process Management platform improves the accuracy and speed of the claims adjudication process.