Those processing medical claims depend on the use of numerous administrative codes and medical terminology to perform these tasks. Typically, five to fifteen different code and medical terminology sets are used within a processing environment. When updates to these code sets are made available from the different standards bodies, the challenge is to accurately incorporate these updates in a timely manner -- and keep them relevant to the adjudication rules already established within the processing system. This updating process is streamlined with the use of the LE solution.
Government
Regulatory compliance of billing and reimbursement processes is impacted by frequent updates to claim edits and code sets - updates that can take a significant amount of time. The ability to audit the methodology and rational of these changes allow for proper compliance. HLI technology documents the methods and user rational for all changes.
Health Plans
Managing administrative and medical costs drives the need for staff productivity and the ability to identify members requiring healthcare services. Updating the administrative code sets on a frequent basis demands considerable resources and, when not performed correctly, will increase the time required for claims processing. Keeping data accurate and consistent within medical concepts over time is critical to finding predictive indicators of patient care. The LE solution can streamline content updates and help canonicalize the data.
Insurance Carriers
The need to synchronize updates of multiple systems in numerous locations requires considerable coordination and time. The ability to provide a centralized source for all administrative code and medical terminology updates would simply the process, thereby reducing the cost of maintaining these controlled vocabularies. The LE solution provides this ability for centralized distribution of content.