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IndiaOverview
The healthcare industry is evolving rapidly, driven by the demand for innovation and efficiency in claims processing. Meeting the expectations of payers, providers, and patients requires embracing self-service capabilities, adaptability, and advanced technology solutions.
What Drives the Future of Healthcare Claims
Self-Service & Frictionless Interactions
Adaptability to New Care Delivery Models
Transparency in Pricing and Services
Personalized Processing
Speed of Claims Processing
Integration of AI and Analytics
Despite these driving forces, payers often struggle to meet these evolving demands. This results in complexities across the claims lifecycle, frustrating stakeholder experiences, and a loss of competitive advantage.
Innova’s digital acceleration solutions bridge these gaps, transforming healthcare claims processing with cutting-edge technology, seamless integration, and a commitment to improving outcomes for all stakeholders.
Common Challenges Payers Face Throughout the Claims Lifecycle
Intake
- Missing or incorrect information
- Lack of standardization
- Steep learning curve
Pre-Adjudication
- Rules-based processing
- High level of customizations
- Non-contextual processing of information
Adjudication
- High turnaround time
- Collaboration challenges
- Limited accessibility to the latest claim information
Post-Adjudication
- Unassisted Explanation of Benefits (EoB) / Explanation of Payments (EoP)
- Difficulty scaling or upgrading to new payment mechanisms
Post-Pay
- Challenges in reporting, tracking, and review
- Issues with reconciliation
Architecture
Driving Transformative Claims Lifecycle Improvements with AWS Expertise
FEATURES
Imagine a Zero-Touch Claims Processing Future
Real-time Claim Adjudication
Automated Prior Authorization
Real-time Fraud, Waste, and Abuse Detection
Seamless Payer-Provider Data Exchange
Industry-Wide Interoperability
Real-time Reimbursements
BENEFITS
Transformative Benefits of State-of-the-Art Claims Management Process
Elevate Customer Experience
- Improve member engagement by over 50%
- Reduce churn and Improve STAR ratings
Streamline Claim Operations
- Improve overall digitalization of billing and claims by up to 50%
- Achieve over 75% integration with provider and internal systems
Efficient Claims Processing
- Improve auto-adjudication rate beyond 85%
- Reduce administrative cost per member per month
Improve Accuracy
- 25% claims cost reduction via real-time fraud detection
- Minimize overpayments
Innova Edge
Years in Payers Services
Healthcare Engagements
Strong Healthcare Team
Everest Data Analytics Healthcare
Everest Payer Digital Services
Ready to Innovate with Us?