Claims Management - Process Innovation and Technology Resulting in Cost Reductions

Client: A major TPA

The Challenge:

Prohibitive labor costs and considerably higher turnaround time due to large numbers of manual adjudications caused by mismatched information between enrollment data and provider data.

The Solution:

Vee Technologies designed a solution that complemented the client's system. Mismatched claims are verified against the client's database and relevant matches are reported back. The provider records which did not exist or did not match are added to or modified in the system enabling auto adjudication.

The Benefits:

Manual adjudication rates were reduced by 77% resulting in savings in labor and reduced turnaround time.