Insurance providers meeting today's challenges with Initiate software for Healthcare

Insurance providers know that there is considerable room for improvement in the auto-adjudication process. Studies show that for every dollar spent on a health insurance claim, eight cents goes to administration while only two cents contribute to the bottom line.

Payer organizations report that 35 percent to 60 percent of claims fail auto-adjudication. This translates into a "first-pass ratio" of only 40 percent to 65 percent of all claims. Identity errors and incomplete records make it difficult to understand which patient is eligible for coverage—especially in situations that involve managing cross-plan payments for services performed while the insured patient was out of town or visiting a doctor other than their primary practitioner.

By making the claims payment process faster and more efficient, you can rapidly reduce your administration costs and increase your profits, while also improving member satisfaction. Since provider and patient identities often reside in disparate databases ranging from physician office billing systems to those found in acute and other provider locations, the key to improving the payment process is being able to accurately identify, match and link patient records—on demand—to support your auto-adjudication process.

Merely merging information to create a data warehouse is not enough. Traditional Enterprise Master Person Index (EMPI) solutions are not only costly and disruptive to your business processes; the newly merged data that is accurate on "Day One" also will require substantial ongoing management resources to remain accurate. There are some EMPI solutions that physically merge data into a single data warehouse or use a master list of unique identifiers that can be associated with a person and a limited set of historical information. These approaches require additional overhead to manage the unique identifiers, and they only work when the information is continually updated.

A true patient-data integration solution requires total access to up-to-the-moment information from across all of your information sources in real time. But the barriers to achieving this are real:

• Traditional data integration processes are costly and invasive and can cause disruption during the migration from legacy systems to newer technology
• The conversion process often creates duplicate medical records, reducing the expected benefits from the new system
• Information is stored in disparate, incompatible systems
• Organizational issues often impede standardization and/or change

The foundation for supporting improved auto-adjudication

Initiate software for Healthcare, the leading EMPI, can be the lifeblood of your patient data integration strategy. We can leverage the data from across your enterprise to create the complete, accurate patient profiles you need to streamline claims processing, improve first-pass ratios, drive profitability, increase member and provider satisfaction; and achieve more consistent HIPAA compliance.

Initiate products and services provide you with a strategy to manage patient identities on demand, while also delivering the technology to achieve outstanding results every day, regardless of how your business needs or regulatory compliance mandates changes. We enable you to dynamically link all of the records about the same patient across your systems and sources, in real time, without physically merging or integrating your data. This enables you to provide access to patient information when and where it's needed, without forcing you to move large quantities of data, standardize systems or require a unique patient identifier.

Simply stated, our EMPI provides the most accurate, non-invasive, efficient method for instantly linking all of your records about each of your members and their providers.

Initiate software enables insurance providers to:

• Create a trusted system of record for your entire enterprise, from members to providers and everything in between
• Leverage your existing infrastructure while minimizing ongoing maintenance and management costs
• Improve processing efficiencies, especially auto-adjudication rates
• Reduce fraud and improve compliance with HIPAA and state-level regulations
• Enable individual data "owners" to maintain control of their information
• Eliminate data latency
• Improve member and provider satisfaction
• Decrease service costs

We deliver:

• The most accurate results on demand, regardless of volume
• The scalability and flexibility to add sources as need be, whether through mergers or acquisitions or through sheer growth
• New insight for your organizational and patient care needs
• Data profiling and basic set-up in under one month
• All without forcing you to move large quantities of data, standardize systems or manage unique identifiers

 Learn more about Initiate software.