Keys to Successfully Automating Medical Claims Recovery


Any casualty insurance industry requires a combination of highly skilled claims coupling with efficient processes and cosmopolitan technological equipment to facilitate prompt and persistent claims handling. An industry, which handles its system by using technical process stride with more productivity from which customers remain loyal, and administration see rapid results.

This article discusses issues confronted by hospitals in using traditional methods of assisting patients and examines the benefits of automating medical claims. It offers some critical technological patterns useful for resolving issues to ensure speed and accuracy from the insurer’s end.

The Present State

The customary process of delivering and receiving medical claims does not seem to be bothersome. However, it can cause a delay in the workflow process that can harmfully impact the healthcare industry. Payments and remittances of insurers, along with drafting and payment check, are generated within the traditional method of claims that can overload the work process of the industry. To mitigate or eliminate this time lagging, insurers have now resorted to using automating medical claims methods for rapid delivery and reception of payments or remittances.


Healthcare industries witness significant time allocated for customers’ billing inquiries, which cause a delay in resolving issues to retain customers’ trust. The poor performance of any industry cannot sustain the reliability of customers as long as they are not provided quick medical service. It is estimated that as much as 30% of payments have exacerbated payment inquiries and disputes within it. In the traditional payment process, medical claim representatives spend much time dealing with payment inquiries from customers that affect their capability to handle claims efficiently to ensure customers’ satisfaction.

The US healthcare reports have indicated that paper-based medical claims are expensive, with $30 million spent on 145 million claims. On the contrary, the cost of the same claims by using electronic methods incurs not more $2.7million. It has also been reported that paper-handling causes fraudulent cases of patients who have not suffered from the illness in which was published in their records. Automating medical claims causes less risk in handling the medical record of patients and speed up the process. It will also eliminate checks sent to the wrong providers.  


The challenge for any insurer is achieving a better payment procedure for the rapid recovery of medical claims and, at the same time, lessening operational expenses. It will result in the consistency and accuracy of the service.

Proceeding with Electronic Funds Transfer (EFT) sans electronic advertisement method can pose a severe challenge for the insurer to receive payments and remittance on a timely basis. An ideal automating recovery of medical claims will enable the healthcare industry to deliver error-free remittance information. Automating method does also include the extensive keeping of payment records involving payments dates, payments amounts, bookkeeping system, and reconsideration or supplement activities of medical bills. Overcoming challenges of customary practices will bring many benefits to the insurers, which meet the productivity and satisfaction of customers. Additional benefits involve accuracy in payment procedure along with the elimination of fraud mailings.


Not every payment pertains to a medical bill, nor every beneficiary needs an electronic payment procedure. The appropriate solution is the provision for automating payments via different mediums of payment, including Electronic Funds Transfer (EFT), as well as electronic mailing to benefit both the insurer and the customer. Automating recovery has an essential role in improving the management of medical claims and rates of reimbursement.

Tackling Payment Management Bottlenecks

Many healthcare industries find themselves in shackles when it comes to the reimbursement process. The majority of their accumulated revenue depends upon fee for service system. How can successful healthcare organizations then ensure best practices for success in the reimbursement process? The answer to this lies in analyzing key factors that impact the revenue cycle and looking for an implementation of those models that can support valid billing and claims management. This understanding is essential when large health organizations latch on to independent practices. As far as the revenue cycle is concerned, it is dependent upon the process, infrastructure, and professional management of the period.


Healthcare industries ought to look at the benefits of automating medical claims recovery that eliminate fraudulent billing/emails as well as ensure rapid delivery of payments and remittance, which will resultantly reduce the workload and increase organizational efficiency. Claims workforce that working in a traditional inefficient environment will influence expensive medical dealings, which will directly impact customer’s medical claims service. It will also affect the profitability of the insurer. Modern payment procedures and rapid solutions to customer’s concerns can improve the overall performance of the industry. An adequately designed technological environment will also fulfill future needs, and the organization must consider pursuing the above benefits.

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