Efficiency, accuracy and automation. These are three important goals for any claims operation. The more claims can be adjudicated automatically, the lower the cost, the higher the productivity, accuracy and profitability. Poor provider data quality significantly affects your claims operation - when provider information is outdated or inaccurate, a growing volume of claims fall out of the automated process and require manual intervention or adjustment. As a result, work backs up, errors and rework increase, and penalties can be incurred.

 

Your bottom line. It may be your most important business obligation. There's no reason why poor provider information should stand in the way. But all too often, that's exactly what happens. You see it in the financial accuracy of your claim payments, the associated cost of research and rework, performance guarantee penalties, and unnecessary fines paid.

 

A small improvement in financial accuracy can make a significant difference.

 

A plan that covers 500,000 lives typically pays about 5 million claims a year, and the payment per claim typically averages about $250. That's $1.25 billion in claims paid per year. If your financial accuracy rate is 98%, that's $25 million going out the door incorrectly. A good portion of the dollars in error can be attributed to provider information and selection. Typically, 30-40% of a payer's provider records contain errors or are missing data. If by improving your information you can get just 10% of those incorrect payments right the first time, you can affect what happens to $2.5 million in claims. And that can make a big difference to your bottom line and cash flow. Your first win is keeping all the funds you can't recoup, rather than writing them off. Your second win is saving the money it takes to attempt to fix the problem. The operational costs you can save from attempting to identify, collect and reissue payments are significant. You also save the downstream work of updating annual statements. And, you improve your relationships with your providers.

 

And that's not all. Financial accuracy affects how your independent auditors view your organization, and may affect how they conduct your audit. Failing to meet financial and payment accuracy objectives due to poor provider information quality can also result in non-compliance with state and federal mandates, appeals and late payment interest. In short, every incorrect, incomplete and outdated provider record affects your bottom line - and in the aggregate it's a probably a very significant financial issue for your organization. This inefficiency also makes accurately projecting quarterly IBNR (incurred but not reported) numbers a guessing game instead of a science. There has to be a better way.

 

And there is. Enclarity can fix your provider information problem now, improving your financial accuracy, and putting money back on your bottom line. Enclarity's ProviderPoint® quickly transforms claims efficiency and accuracy. In addition, it efficiently standardizes, cleanses and augments your claims and your provider files - and matches them precisely.

 

Our ProviderPoint family has grown to include specialized solutions for improving claims management. ProviderPoint for Claims Cleansing enables healthcare payers to automatically validate and correct key issues on claims, and stay alerted that research is needed about the provider (rendering, billing or referring) as each claim is submitted. Another Enclarity solution, ProviderPoint for Claims Indexing, identifies and links unique healthcare providers across claims stored in databases or a data warehouse, regardless of changes to name and business affiliation, TIN, Provider ID, practice or billing information over time.

 

Powered by Enclarity, your provider information can stay accurate and up-to-date, improving your auto-adjudication rate and financial accuracy, which in turn improve your results and your projections.

 

Returned mail and re-issuing of checks can drop dramatically. Penalties, fines and late payment interest will decrease. Instead of reacting to the chaos created by poor provider data, you can be proactive and stay on top of the constant changes in provider information. By improving the financial accuracy of your claims processing, your bottom line can look better than ever. And that's something you can take to the bank.

 

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