4 Challenges Blocking Payers From Smarter Operations

A practical playbook for health plans to remove intake bottlenecks, improve data quality, and connect communications and support—so operations run faster, more accurately, and in compliance.

Takeaways:

  • Fix manual intake that creates data bottlenecks.

  • Standardize and validate data to improve claims performance.

  • Unify communications and reconciliation to reduce errors and delays.

  • Connect support channels to cut handle times and admin burden.

Are Data Bottlenecks and Claims Delays Slowing You Down?

No health plan is perfect. But the more legacy systems, manual processes, and volumes of poorly formatted data you have, the higher the cost of inefficiencies when it comes to people, process, and technology.

This playbook helps you uncover:

  • The value of visibility–and accountability–across the entire payer lifecycle

  • How to create a foundation for scalability across all lines of business

  • Ways to optimize compliance across all business units

  • Strategies to enhance member trust and loyalty through integrated communication and reconciliation channels

Top Opportunities to Optimize Payer Operations

  • “Underpayment of claims ends up costing health plans more, because they have to do the rework to pay the right price. There’s the organizational burden, and then there’s also ‘hidden costs’—like provider abrasion. Data that isn’t standardized and validated before it enters the claims lifecycle could cost you when it comes to contracting times with providers.”

    — Malcolm Smith, Vice President of Claims, Imagenet

  • In most states, health plans that fail to process claims within the state’s prompt-pay time period are required to pay interest to the provider, sometimes as high as 18 percent annually.

  • “Transitioning to a digital mailroom—which takes on all aspects of processing paper claims and other documents—presents a significant untapped opportunity for health plans to reduce waste, accelerate processes, enhance quality, and meet regulatory requirements.”

    — Vidhya Bhat, Chief Product Officer of Digital Transformation, Imagenet

  • Call centers with lower wait times generate higher rates of loyalty. Customers who are satisfied with wait times are 3 times more likely to recommend a brand and 2.6 times more likely to trust a brand. — Customer Experience Dive

Get the Playbook. Build Future-Ready Operations.

Don’t let your inefficiencies become liabilities. Access actionable steps to optimize operations, control costs, and strengthen compliance.

 www.dhs.gov/E-Verify E-Verify® is a registered trademark of the U.S. Department of Homeland Security