INSURANCE BACK OFFICE: PEAK HANDLING & AUTOMATION
Insurance Pre-screening and Validation Process
Insurance providers typically receive high quantities of insurance claims each day. Each insurance provider may have their own submission standard and format in which the claim application should be followed. Claim submissions can contain many errors (e.g. redundant, wrong or missing supporting documents, wrong formats). The clearing and formatting task for each claim is time-consuming and complicated. Our operators receive extensive training and have deep knowledge of insurance claims in order to be able to recognize and correct errors in a timely manner.
DIGI-TEXX‘s operators will connect to the insurance company’s system to edit claims directly, classifying applications and scrubbing out any errors. The insurance company reduces costs and procedural errors while improving its competitiveness thanks to DIGI-TEXX‘s BPO services. At DIGI-TEXX, we handle different types of insurance documents regardless form format: Claim form, ID card/passport, Investigation reports, Medical records, Histopathology report, Operation theatre notes, X-Rays, Lab reports, Blood tests, Supporting invoice, Hospital main bill, Break-up bill, Receipt for amount paid in the hospital, Prescriptions for medicines and so on.
Moreover, after holiday seasons when the insurance client may experience high variance in claim submission volume, DIGI-TEXX‘s service continuity is still guaranteed.
The insurance claim process is an interaction between a healthcare provider (e.g. hospitals, clinics) and the insurance companies as payers. During this claim process, for accurate billing purpose, after a visit, the doctor’s diagnosis is translated into a series of insurance codes (e.g. Codes Current Procedural Terminology).
Different doctors/healthcare providers have different styles of diagnosis writing, many in handwritten format. In reality, this can be very challenging for insurance makers while processing insurance claim to insured person/patient, at the end prolonging the waiting time for customers and affect the competitiveness of our insurance clients.
Our team at DIGI-TEXX takes part in the claim process by matching the diagnosis blocks with the international insurance codes. There can be some billions of possible code combinations, while the diagnosis notes are different from one doctor to another. The work is done in the cloud system of our insurance client. We offer a full solution of processing diagnosis content. Our advanced ORC automatically detects and extract the relevant terms. The look-up database suggests the standard coding while our expert operators validate the make sure the standard coding suggested are true for the written or printed terms. The standard, clean and clear digital diagnosis will become the main data sources for the rest of the claim processing circle.
With DIGI-TEXX service, our insurance client can effectively automate its claim and payment process. Moreover, our services reduce the insurance company’s mismatching of codes, ensuring the correct billing in a short time.