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Most health plans have claim auto-adjudication rates around 50%. Consequently half of all claims suspend and require claim examiner intervention. These claims often have complex turnaround requirements, and a broad range of skill-sets required to process them. On a daily basis, a claim staff spends much of it's time managing the distribution of these claims, an often laborious and repetitive process. The effort involved with these activities are exorbonate and costly.
ProClaim© is the solution. It automates the organizing, assigning, and distributing of suspended claims. ProClaim plugs into any processing system including PowerMHS, Facets, and others, at a fraction of the cost of other workflow products. Its real-time, web-based functionality services up to 10,000+ user base, allowing staff to manage and monitor daily activities based on instant feedback. The efficiencies gained through ProClaim minimize interest penalties, enable achievement of timeliness goals, and increase processing speed. More..