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OpenSpan Claims Automation Service


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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 business

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OpenSpan Claims Automation Service

  1. 1. a better way to workTMfor Healthcare
  2. 2. Approach for Health Payers3 OPENSPAN PROPRIETARY & CONFIDENTIAL
  3. 3.  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 ROIEmulate the observations, decision and actions – or more simply, theeyes, brains and hands – of your claims examiners.Access the data necessary to settle a claim without requiring ITresources to build services, provide APIs or develop extracts.OPENSPAN PROPRIETARY & CONFIDENTIAL4Overview
  5. 5. 7© 2006-2013 by OpenSpan, Inc. All rightsImplementing the Claim Automation ServiceYour numbers may vary
  6. 6. Use Case Examples8 Pre-X Wellness Duplicate Checks Provider Management Prompt Pay Authorizations Adjudication Edits Pricing Overrides Capitation Tiered Benefits Corrected Bills Coordination ofBenefits Processing PaperClaims 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 NotationOPENSPAN PROPRIETARY & CONFIDENTIAL
  7. 7. 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 optimization9 OPENSPAN PROPRIETARY & CONFIDENTIALOpenSpan Investment inbusiness relationship with client