How New Technology Can Help Claims Managers

Written by Kevin MabryHealthcare, HIPAA


It (IT) has lengthy been touted because the answer to improved business processes. So, how’s IT evolving to make a claims manager’s existence simpler, better react to patients’ needs, meet mandated guidelines, ensure patient privacy, and produce efficiencies towards the overall process?

New advancements, for example electronic data interchange (EDI) systems which help connect insurers to patients and physicians, have previously made their mark within the medical industry. Virtually every large provider or hospital delivery system has some kind of EDI system in position. Electronic permanent medical record (EMR) systems contain the commitment of making patient information available to both sides, whenever anywhere, yet only seven percent of today’s providers have EMR systems in position. And, how can claims managers tie in to these systems safely and efficiently?

Based on the 1996 Medical Health Insurance Portability and Accountability Act (HIPAA) legislation, all U.S. medical service providers and payers need to ensure they are able to receive and send private health information pursuant to HIPAA law by utilizing standard, HIPAA-compliant code sets HIPAA-compliant transactions eliminate all proprietary and/or local codes for waived services, and accommodate unique identifiers for providers, health plans (payers) and employers. When the HIPAA EDI standard is fully in position, it can help reduce management overhead and charges.

The following wave of technology advancements may lie directly on the web. Internet-based Websites contain the commitment of helping claims managers enhance the overall claims review process by enabling these to collaborate using their customers and vendors digitally. Including requesting and receiving independent medical reviews, with HIPAA-compliant transmission of medical records along with other sensitive PHI.

As new types of electronic data exchange emerge, claims managers can expect to a different era with improved change occasions more manageable, lower costs elevated security, and improved HIPAA compliance.


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