2016 and Beyond (pdf)
The transition to ICD-10 and the resulting increases in historical claim and clinical information promise to add fuel to the healthcare community’s drive to empower consumerism. The ICD-10 transition provides opportunities that add value to healthcare organizations within the following value streams: business analytics, operational efficiencies, payer-provider contracting, and consumer-centric quality improvements. Health plans can start to capitalize on each of these value streams to drive new business opportunities and payment models and to ultimately support and increase patient/member satisfaction.
Health Claims Processing in the US (pdf)
There is no single method for processing health claims. In fact, system vendors and health plans would argue the uniqueness of their particular system and its advantages over other systems: the security of a port of entry into a mainframe system, the customization associated with service-oriented architecture (SOA), etc. Despite system differences, there are common architectural features one would find in any good health claims processing system.Click on the link above to learn more about health claim systems necessities, including: