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Do TPAs Really Need Health Insurance Claims Management Software

We are on the verge of 2019, and it is pretty clear that health insurance claims management software will be again playing a dominant role in the insurance industry in 2020. From labor-intensive claims processing to digital claims management, we are living in an era where customers want complete content. The speed of processing claims and accuracy also matters a lot.  However, considering the price range and the confusion between the choices of claims software, is investing in them really worthy? Or an overrated waste of money? Let's figure it out together below.

Speed and Satisfaction

According to a study by Ernst and Young, 87% of policyholders admit that they will change their insurance providers if their claims aren't handled the proper way. Thus, there are no doubts that speed is a major influence is giving customers the satisfaction and claims processing they want. Usually, claims processing used to take around 6 months or even up to a year when claims were manually processed. Scores of untouched claims used to gather under an insurance provider or TPA. With the emergence of health insurance claims management software, the claims processing duration decreased drastically and came down to mere 1-3 months. The number of pending insurance claims also decreased and insurance companies received fewer consumer complaints.


Effects on Claims Settlement

The ways claims processing software affect the settlement amount also cannot be neglected. A common issue that always remained in the industry was to ensure the accuracy of claims settlements. For a long time, insurance providers restrained from providing a plethora of health benefits in their insurance plans due to errors in calculating the settlement. For any settlements that were inaccurate, customers dragged insurance providers to court. However, modern health insurance claims management software was capable of processing more than accurate claims. As the whole adjudication process was automated, there was no scope of error in settlement or fraud from the customer's end. TPA's were able to come up with settlements that satisfied both the provider and the claimant, not to mention the faster speeds at which settlement was processed.

These were some reasons due to which TPAs and insurance providers are still relying on the health insurance claims management software. Not even them, but customers also like to buy insurance from a provider who uses the digital method of processing claims.

We at DataGenix believe in providing equally efficient claims processing means to every insurance provider and TPA. With our ClaimScape software, they can provide medical patients with better help and assistance. To know more about our Claims software range, visit our official website.
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Location: Riverside, CA, USA

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