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Claims Processing |
OutsourceBiz can handle the entire claims adjudication process for clients, providing cost savings, increased accuracy, and faster
turnaround times. With personnel at our BPO Center that are trained to understand medical claims repricing and adjudication, we can handle all functions in the claims processing cycle: |
- Claims receipt, sorting, and scanning
-
Data Entry
(
Dual Entry Validation
99% accuracy)
- Repricing
- Adjudication
- Claims conversion to
EDI
- Workers Compensation Paper
Claims
- Claims data archival and retrieval
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Claims Processing Workflow |
The following diagram illustrates how clients interface with the OutsourceBiz team to handle claims processing: |
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Clients are offered flexibility in terms of how much or how little of the actual claims processing workflow they want to outsource.
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At the most basic level, our BPO Center can perform all data entry for you using our Dual Data Validation
method and produce EDI files which are compatible directly with your claims system. |
At the most advanced level of our claims outsourcing service, our BPO Center will manage all aspects of the claims processing workflow
for you including repricing and adjudication functions. |
HIGHLIGHT: DUAL VALIDATION |
To achieve optimal accuracy, our BPO Center utilizes a system for data entry validation called Dual Validation. Using Dual
Validation, our BPO Center requires all claims to be entered IDENTICALLY by two separate data entry operators. If both operators do not enter the exact same information for the claim, then the claim data
entry is rejected and the operators are asked to perform the data entry process again. This process enables us to provide 99% or better accuracy in our data entry process, ensuring that fewer claims are
rejected during adjudication. |
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