HEALTHCARE PROCESS MANAGEMENT

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.