Healthcare Claims Management
Streamline filing, adjudicating and communicating about claims.
Request a DemoOptimize Claims Management in Healthcare
Claims represent the largest expense for health insurers. To optimize the medical loss ratio (MLR), insurers must guide members to the most cost-effective products and services and negotiate with providers to minimize payouts. Smart Communications helps insurers minimize claim administration expenses and maximize profitability. Read on to learn how.
Streamline Member-Submitted Claims with SmartIQ™
While member-submitted healthcare claims are usually <10% of claim volume, they’re very costly to process. SmartIQ significantly reduces the effort required for members to submit claims. Integrate SmartIQ with core systems and third-party services to pull in data and attach supporting documentation to minimize manual entry for 100% clean claims.
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Reduce Appeals and Grievances with SmartCOMM™
Studies show that roughly one-third of members do not understand how claims are paid. The same studies call on payers to improve the clarity of claim-related communications to reduce appeals and grievances. Use SmartCOMM to improve the readability of text and include charts and graphs to illustrate the relationship between claims and co-insurance, deductibles, and out-of-pocket maximums.
Connect SmartIQ to SmartCOMM and Enable Self-Service
Insurers direct members to contact the call center with questions about claims. Not only is this inconvenient for members, but it also drives up call volume. Instead, use SmartCOMM to include a link in the EOB to a SmartIQ-powered guided interview and enable a new self-service option for claim-related inquiries.
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Ready to Reduce Costs with Effective Claims Management?
Transform manual, paper-based claim forms into guided digital interviews, and deliver clear and engaging communications on your members' preferred channels. Request a demo and see first-hand how we can help lower your claim administration costs.
Innovative Approaches to Healthcare Claims
Use our data collection and communication tools to reduce time and eliminate costs.
Improve the customer experience of member-submitted claims
Increase clarity by adding charts and graphs to EOBs
Automate the adjudication process for member-submitted claims
Improve the readability of correspondence using AI-assisted content analysis tools
Reduce call volume and remove roadblocks related to claim inquiries
Automate through integrations with core systems, decision and workflow engines
Route appeals directly to your Appeals & Grievances team
Reduce claim communication-related call and appeal volumes
Connect Claims and Appeals for Cost Savings
What if your members' could simply click a link to ask a question about a claim, instead of having to call? How much time and money would you save if you had the ability to connect a Level 1 appeal directly to your Appeals & Grievances team? Watch this video and see a demonstration of how Smart Communications can create a connected claims experience for you.
Curated Content Related to Claims
The following resources speak to optimizing one of more points along the claims customer journey.
Ready to Transform Your Healthcare Claims Management?
Explore how SmartIQ and SmartCOMM can enhance both your members' experience and the operational efficiency of claim submission and communications.
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