Health Claims Management


Insurers are realizing that improving their health claims processes has a significant impact on the business. Efficient claims management helps insurers improve customer experience, reduce processing costs and time, adjudication errors, and increase regulatory compliance.

Datamatics helps insurers and payers transform their claims management processes by leveraging the power of Robotics.

Our insurance clients have reaped significant benefits in terms of cost, speed, and accuracy by using TruBotTM, our Robotics product powered by Artificial Intelligence, for claims processing and management.

Datamatics uses Advanced Imaging technologies 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’ milestones in Claims processing arena


Benefits of Claims Automation:

  • Lower processing costs (reduce cost per claim)
  • Better risk management (intelligent underwriting and fraud detection, more effective adjudication)
  • Superior customer experience (faster settlement for proper claims)
  • Decrease Turnaround time
  • First time right
  • Accuracy


What we do?


1. Payer Services:

We provide end-to-end claims management automation services, which include:

  • Mailroom & Scanning: Provides exceptional processing speed and accuracy catering to all payer requirements
  • Claims Management: Offers claims registration, claims verification, claims settlement & disbursement, fraudulent claims management, audit, etc.
  • Claims Pre-adjudication: Adjudicate claims forms with minimal errors
  • Adjudication Services: Facilitates faster settlements and lowers healthcare costs per claim
  • Member and provider matching: Ensures accuracy in payments processing
  • Sales & Underwriting: Offers effective contract management, sales automation, quote and rate underwriting, risk classification, and pricing solutions
  • Membership Management and Billing: Ensures complete automation of the data management system to facilitate new membership enrolment, renewals, eligibility checks, monitoring, and client billing
  • Care Management: Presents user friendly, Omni-channel care management that helps payers provide on-demand support to patients
  • E-Portal: Offers interactive web portals to enhance member-provider engagement and interaction
  • Business Intelligence & Data Warehousing: Offers a comprehensive analytics suite facilitating provider management, fraud analytics, predictive modelling, enterprise data management, and HEDIS reporting


2. Provider Services

  • Revenue Cycle Management Services: 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
  • Payment Posting Services: Covers enrolment process, payer database, member database & credential verification. Datamatics verifies the eligibility of the insurance holder through multiple modes, which include a proprietary tool, IVR, as well as through a customer care representative.


3. CRM Services

  • IVR Solutions: Offers all patient communication on a single platform; automates the hospital's precision care workflows and guides the patient through real-time data access
  • Customer information: Maintains updated records of patient information and related contact details
  • Enterprise: Provides services and software for quality management, regulatory compliance, and F&A management