Time-Saving Healthcare Solutions in the Tungsten Marketplace

The healthcare industry is massive and complex, from providers to insurers. So, too are many of the tasks that organizations in the industry must handle, be it handling thousands of active insurance claims or managing the burden of regulatory compliance. The nature of this work has typically been reliant on manual work across disconnected systems. Modern healthcare solutions, such as those in the Tungsten Marketplace, effectively transform that work to save time and improve outcomes.

Reducing turnaround times in key workflows unlocks many benefits. For example, it provides opportunities to redirect valuable human effort to other activities and improve customer service experiences. In the realm of compliance, speed and accuracy ensure organizations align with the law and maintain that stance. Find a fast path towards more efficient work and a clear ROI from automation with solutions from Tungsten Automation and our partners in the Marketplace.

Let’s take a look at some of the ways you could save substantial time.

Transform Claims Processing With CLAIMSAutomate

Among our trusted partners, AI Global Solutions (AiGS) consistently innovates to deliver exceedingly functional solutions that transform intensive workflows. According to AiGS, the claims processing workflow is one of the largest costs for insurers handling personal injury and healthcare policies. With many steps and considerations alongside standardized forms, processing claims can take a long time. The longer it takes, the worse the experience for the insured and, in the case of healthcare claims, potential delays in care.

CLAIMSAutomate aims to help stop the leaks and resolve the inefficiencies that often make claims processing so expensive. This solution brings automation to the key task of processing UB-04 and CMS-1500 style claim forms. CLAIMSAutomate classifies claims and captures data directly from the forms. At the same time, it applies user-configured business rules from a library of hundreds of pre-configured setups. The solution also includes a web portal for managing rejection discussions with providers for claims resolution.

After extraction and classification, CLAIMSAutomate packages the data into the EDI format for further processing. The whole solution reduces the need to rely on manual, paper-based processes while delivering consistency and reliability in the data your organization handles. This can save considerable time and accelerate the claims process to provide better outcomes for the business and its customers.

Manage the Grievance Process for Stronger Compliance

Handling healthcare grievances or claim appeals is a process that also consumes a significant amount of time. It can also be a substantial source of stress due to the existence of regulatory timelines for the resolution of appeals and grievances. The Center for Medicare & Medicaid Services and the Affordable Care Act include such timelines.

The purpose of such timelines is to ensure the prompt resolution of issues raised by patients, providers and caregivers. Organizations may face punitive results if they fail to complete a grievance workflow or a claim appeal in the appropriate window. However, manual steps and hand-keyed data entry can slow down these efforts, especially at scale when there may be dozens or hundreds of open cases at any given time.

Saving time here is essential, and the Marketplace features a solution you can rely upon to enhance productivity.

The Appeals and Grievances Solution by Reva helps automate key steps in this process. New cases are automatically routed to the user on your team responsible for handling the case. If that user does not respond promptly, the solution automatically escalates an alert to bring attention to the matter.

This Reva solution also ensures more accurate case data capture to help populate critical systems where users will need the data later. Every case has all its documents and related correspondence centralized into one repository that’s easy to view, share, and audit. This solution provides an end-to-end audit trail to support stronger compliance, too. This solution can save substantial time and improve compliance outcomes by reducing the need to manually manage these storage and processing requirements.

Investigating Time-Saving Solutions for Your Organization

Managing appeals and grievances. Working through medical claims processing. Gathering case information. These are all everyday tasks in healthcare, and they all commonly take a significant amount of time to process with extensive human involvement. As we’ve seen, there are solutions ready to deploy today that can shave hours off processes and bring agility to operations that typically create bottlenecks.

With the Tungsten Marketplace, tapping the power of these and other healthcare solutions is easy. Many solutions, including AI-powered resources, can also support healthcare organizations and their back-office operations. How much time is your healthcare operation losing to clerical and compliance tasks? How much time could you save with automation? Dig deeper into the Marketplace today to discover what’s possible.