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Claims Solutions That Power Profitability

Increased cost pressures, regulatory uncertainty, and membership flux make it difficult to unlock the value of claims data. Abandon the spreadsheets and manage claims code sets, increasing first pass auto-adjudication rates and reducing inaccurate claims.

Improve Claims Accuracy with High-Quality Data

Avoid Lost Revenue

Reduce financial exposure by identifying, recovering and preventing overpaid claims by ensuring your claims systems are leveraging the latest updates provided by CMS and the AMA.

Minimize Manual Reviews

Scale data efforts and manage claims codes using software, reducing errors and administrative costs by providing workflow and collaboration tools to properly approve and update claims codes.

Improve Compliance

Comply with state requirements and ONC regulations that require data access and sharing, while improving data quality that informs decision making.

Reduce Inaccurate Claims

Increase first pass auto-adjudication rates to decrease the processing of inaccurate claims, improving provider satisfaction.

How We Help Health Plans

Wolters Kluwer helps health plans manage claims code sets using a combination of software, data and services, reducing the manual work required to update lists of codes used for reimbursing claims from your provider networks. Up-to-date codes ensures accurate data is being used across your claims operations using the latest updates from the standards bodies.

What’s At Stake?

  • Up to 60-70% of provider-submitted claims have incomplete or incorrect data
  • There are stiff penalties in some states on claims that take longer than 30 days
  • 1 in 5 medical claims submitted are processed incorrectly, costing up to $15.5 billion in unnecessary administrative expenses
  • An auto-adjudicated claim costs health insurers just cents on the dollar, while one that needs human intervention costs ~$20 per claim

How We Help Align Your Data

Looking to learn more about our data solutions for health plans?

Access reliable, actionable data to improve member care, boost quality measures, and support value-based reimbursement. Wolters Kluwer delivers a powerful combination of expert consulting, comprehensive services and leading technology that can help you build the foundation for sustainable results. Get the most out of your enterprise data with an end-to-end data management portfolio tailored to the needs of health plans.

Speak with one of our health plan specialists

Insights

In our previous blog, we discussed the importance of leveraging administrative data for better quality assessment. As the wrap-up to this standards blog series, I want to look back at Crossing the Quality Chasm as a foundational work for improving the quality of healthcare delivery.

Patients are demanding better insights and transparency into their care. They want to be empowered in their decision-making through better information about everything from diagnoses and care plans to quality ratings and cost.