What if you could automate data collection and validation and enable your people with better insights to improve customer service?
WorkFusion enables HealthCare and Life Sciences organizations process large volumes of unstructured data rapidly and accurately to improve patient outcomes
Intake Healthcare claims received from providers and patients and expedite the processing of claims accurately and on-time
Eligibility of Benefits
Coordinate between patients, providers and payers to review treatment eligibility
Provider Verification & Credentials
Update and verify provider information in payer databases
Work with claims adjudicators to audit claims to identify waste, abuse and fraudulent claims
Input various reports from multiple channels regarding adverse drug events and convert to required regulatory formats for processing
Healthcare Claims Processing
HealthCare plan administrators a.k.a as Payer’s are a key component in the healthcare ecosystem along with care providers and patients. The ultimate goal of every Payer organization is to ensure that all claims received are processed accurately and on-time to ensure patients are satisfied and providers are accurately reimbursed for services.
reduction of manual effort overall in the claims administration process
Volume: The claims submission volume is very high (depending on size of organization). In addition, claim documents are submitted in various formats (fax, email, FTP batches, handwritten forms etc) and need to be consolidated into standardized formats in accordance with regulatory standards before processing is done
Time: The amount of time taken to intake a claim, adjudicate, quality control and respond to patients/providers is a process that Payer’s continuously aspire to reduce but are challenged due to staffing constraints
Precision: Errors in processing claims accurately can result in significant financial losses and regulatory penalties which ultimately impacts patient satisfaction and outcomes
WorkFusion significantly improves the claims administration process by improving the quality and speed of claims in-take and the verification of benefits to speed up adjudication and payments. Our solution minimizes the need for manual intervention by automating processes leveraging Machine Learning capabilities.
Our solution is geared towards helping Healthcare organizations redirect resources towards critical client facing activities
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