Healthcare Claims Processing – Assuring Accuracy & Profitability
Healthcare Claims Processing Assuring Accuracy & Profitability
Inside the healthcare industry, the success of any healthcare service requires that the vast amount of information in the IT system remain continually available and that any transactions that interact with this data perform adequately. This is the information upon which claims decisions are based. Along these lines, it is also very important that the claims processing structure be effective and traceable.
The details of every transaction connected with a claim need to be visible at all times. The claims possessing system needs to stay in continual operation, or not only will operational costs rise, but important patient data may be impacted as well.
Role of Business Transaction Management in Accurate Healthcare Claims Management
Business transaction management (BTM) solutions are a very effective method of simplifying IT management, and at the same time improving application performance and availability. The real time visibility into healthcare transactions that BTM provides allows the IT team to evaluate end-user experiences, which is one of the most crucial components when processing claims. When healthcare claims are not handled efficiently, it can be costly from multiple angles.
Whether the healthcare claim is being handled from the hospital/healthcare provider side or by the health insurance side, money is clearly involved. Unfortunately, many healthcare institutions and insurance companies overlook the "stealth waste" occurring every day.
What is stealth waste? It is money spent trouble shooting cascading failures without the right forensic tools or adding unnecessary IT infrastructure. It is money lost when transactions don't complete, so a payment request for services rendered isn't processed or a refund isn't processed correctly.
These are all problems that are addressed by the right business transaction management solution. BTM gives IT departments the tools they need to evaluate the effectiveness of the current process and see where improvements can be made.
BTM Supports Entire Healthcare IT Infrastructure.
Any collapse in service is catastrophic for the healthcare industry. Claims processing is only a small part of the transactions a hospitals and other healthcare institutions deal with on a daily basis. Almost every function within the hospital is computer dependent. Thousands of transactions occur. Without real time visibility the IT team is in the dark when problems occur. All the applications may be reporting that everything is operating normally. Yet, end-users are complaining to the service desk.
The right BTM solution provides the real time, end-to-end visibility needed to track down issues not only after they develop; it has inference capability built right in. It delivers insights into potentialities. It discovers and deals with minor issues before they become cascading problems with serious business-wide issues.
Nastel's AutoPilot What Makes this BTM Solution Different?
Such issues may be caught by other BTM solutions on the market, but Nastel's AutoPilot's design gives it an edge. What makes AutoPilot's BTM solution different? It's integral complex event processing (CEP) engine. The CEP isn't added as an afterthought. It drives AutoPilot's ability to pull data from every application that interacts with the program.
During the course of processing claims, there is a vast amount of data collected, which must be consolidated (e.g. patient visit details, dates of patient admittance, transfers or discharges, lab results, vital signs, radiology reports and medication). Not only does the AutoPilot complex event processing engine keep this data visible and available twenty-four hours a day, it has inference capabilities based on the data it gathers to alert IT about problems before they have serious impact. It also has the ability to prevent them from happening again.
So not only does AutoPilot assist with efficient claims processing; it also keeps the entire IT configuration healthy. No matter how complex the IT environment is, AutoPilot communicates across all platforms, evaluates the data collected, correlates and extrapolates the vital information needed to keep every aspect of a healthcare IT system operating at peak efficiency.
Another capability that differentiates AutoPilot in the marketplace is its scalability. This is an important feature, as it allows healthcare institutions to keep their costs manageable. This increases the ability to remain competitive in the current marketplace.
Combine all the capabilities Nastel's AutoPilot's BTM solution offers improved business process execution, bottlenecks identification, problem prediction and resolution, enhanced application integration , application performance monitoring, etc.and it is easy to see that AutoPilot is a powerful solution for managing more than healthcare claims. It will reduce outages, performance slow-downs and business disruptions across the entire healthcare IT structure.
Pregnant? baby due in winter,emergency birth, giving birth during a blizzard Hemorrhagic Ovarian Cysts - Causes, Symptoms and Treatment Cheap Metal Detectors Are A Great Way To Make Sure Nobody Gets Shot At Your Party Iron Water Filters For A Healthy Life Kidney Cancer Survival Rate Data 5 Ways to Ready Your Home (and your enjoyment of it) for Winter What's the Allure of Body Jewelry? Diabetes - A Disease Of The Pancreas High Blood Pressure Anxiety Attack Disorder - Do You Have Anxiety Attack Symptoms Your Health Is Your Wealth Skincare Essentials For Winters Super Smart Skin Care Methods To Achieve A Healthy Skin Glow