openspan claims automation service
DESCRIPTION
With OpenSpan's Claims Automation service, you can support the process improvement life cycle by iteratively… Discover how users work by monitoring user application navigation and data entry and events to see what users actually do; measure user work processes by analyzing user events to correlate and understand how users work; and ultimately improve how users work by automating user processes – increasing user capacity, efficiency and process compliance, while driving cost out of the businessTRANSCRIPT
a better way to workTM
for Healthcare
Approach for Health Payers
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Replicates a high percentage% of existing processes being performed manually
Decreases cost - reduces the number of claims requiring a human to process
Utilizes your existing applications and current claims processes
Low IT and business resource footprint
Offers value in 30 days and fully implemented in less than 6 months
Provides near-immediate triple digit ROI
Emulate the observations, decision and actions – or more simply, the
eyes, brains and hands – of your claims examiners.
Access the data necessary to settle a claim without requiring IT
resources to build services, provide APIs or develop extracts.
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Overview
Solution Lifecycle
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7 © 2006-2013 by OpenSpan, Inc. All rights reserved.
Implementing the Claim Automation Service Your numbers may vary
Use Case Examples
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Pre-X
Wellness
Duplicate Checks
Provider Management
Prompt Pay
Authorizations
Adjudication Edits
Pricing Overrides
Capitation
Tiered Benefits
Corrected Bills
Coordination of Benefits
Processing Paper Claims
Claim Status Checks
Policy-level Checks
Large Claim Review
Claim Audit
Data Quality Checks
Data Formatting
Out of Network
Provider Updates
Medical Record Review
Auto Log In & Refresh
Customer 360
Transferred Call Data Share
Caller Verification & Disclosure
Application Set Up
Application Synchronization
Previous Call History
Real-Time Guidance
Process Simplification
Validations
After Call Notation
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Engagement Path
• Client pain point
• Benefits assessment
• Technology diligence
• Proof of concept
• Prioritize automation opportunities
• Build and implement claim automation service
• Build and implement claim optimization
• Build and implement contact center optimization
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OpenSpan Investment in business relationship with client
OPENSPAN PROPRIETARY & CONFIDENTIAL