The majority of the effort expended by most claims processing systems focus on auto-adjudication. Unfortunately, there remains a large volume of suspended claims which require attention. ProClaim picks up where the claims processing systems leave off.
The following list are some of the problems faced at health plans for suspended claims for which ProClaim provides the solution:
1. Reliance on paper for suspended claims, no queueing system.
2. No way to allocate work based on the skill set of the examiner.
3. Require expensive modifications for simple segregation (routing) needs.
4. Provides little or no audit trail.
5. Inadequate or incomplete performance measurements.
6. Inability to react to inventory shifts in a timely fashion.
7. During workday,no way to track progress towards a timeliness goal.
8. Aging inventory reports are not grouped together adequately to be useful.
9. Sharing of work between departments is cumbersome.
10. Complete reliance on supervisor's daily efforts to distribute claims.
