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5 Essential Steps to Improve Your Claims Adjudication Process

23 Nov, 20234:40 PM

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5 Essential Steps to Improve Your Claims Adjudication Process

In the healthcare industry, claims adjudication is critical in determining whether healthcare providers receive accurate and timely reimbursements for their services. This process, however, is often complex and prone to errors, delays, and denials, inhibiting the financial stability of healthcare businesses and compromising patient care.

A recent study by the Kaiser Family Foundation revealed an 18% denial rate for healthcare claims, highlighting the need for efficient and effective claims adjudication processes. Mirra Health Care's Claims Adjudication Solution addresses this challenge by providing a comprehensive offering that streamlines the claims adjudication process, reducing errors and improving reimbursement rates.

This blog post outlines five essential steps healthcare providers can implement to optimize their healthcare claims management process with Mirra's solution. These strategies will enable providers to enhance cash flow, reduce administrative challenges, and focus on providing quality patient care.


Step 1: Harness the Power of Automation

The Council for Affordable Quality Healthcare (CAQH) estimates that switching to electronic claims submission can save the healthcare industry $1.7 billion (about $5 per person in the US) yearly compared to manual processing. That has significant financial implications for healthcare businesses. Plus, automation can shave off as much as 22 minutes per claim status inquiry, which adds up to a healthier revenue cycle when applied to thousands of claims every month.

Consider the practical implications. Automation doesn't just mean fewer paper forms; it revolutionizes the entire claims adjudication process. For payers, it simplifies paperwork, speeds up adjudication, and enhances decision-making using interoperable data. On the provider side, automation ensures data accuracy, prevents duplication, and verifies patient identities.

Mirra's Claims Adjudication solution uses automation. It seamlessly translates paper claims into digital records and processes electronic claims. This means ensuring fewer manual entries, minimal errors, and lightning-fast processing. In other words, Mirra helps improve turnaround time and significantly reduces operational costs.

key benefits

Step 2: Front-End Edits and Coding Checks

Front-end edits and coding checks are pivotal stages of the claims adjudication process. These checks meticulously inspect claims, including all coding and data. They act as the initial filters, detecting inaccuracies, missing information, or discrepancies.

With Mirra's solution, front-end edits have become more rigorous than ever. Claims are processed with precision, reducing errors slipping through. An automated system ensures that coding checks are comprehensive, identifying mistakes before submission and saving the time and effort involved in rework.

Step 3: Efficient Data Management

Efficient data management ensures the success of the claims adjudication process. Mirra ensures organization, storage, and analysis of the vast data involved in claims. The aim is to ensure this data is accessible, accurate, and secure and can be efficiently used to reduce claims denials.

At Mirra, our solution isn't just about claims; it's about data, too. It's a comprehensive records system that maintains data efficiently, enabling healthcare providers to view the AR Ledger of their clients. It's a holistic data management solution that minimizes data inaccuracies that would otherwise result in claims denials.

Step 4: Enhance Patient Communication

Leverage patient participation to streamline claims adjudication. Encourage patients to verify and update their personal information through secure online portals. This reduces errors and ensures accurate data. Mirra's Claims Adjudication Solution simplifies verification and updates, making patient communication a breeze.

Step 5: Standardize Claims Adjudication

Standardizing the claims adjudication process ensures consistency across all aspects, streamlining operations and minimizing confusion for healthcare providers. Providers can significantly reduce errors, expedite the claims process, and enhance overall efficiency, improving cash flow and business growth.

key benefits

Addressing Challenges

Standardization isn't without its challenges, especially when operating in an environment with varying payer requirements. However, the right tools and solutions can help providers overcome these challenges:

  1. Standardization Software: Specialized software can navigate the diverse payer landscape, aligning claims with the required standards.
  2. Automation: Automated systems ensure that claims adhere to the defined standards, reducing errors and ensuring compliance.

Mirra customizes its solution to seamlessly integrate into your existing system, aligning with your needs. The automated system guarantees consistency and adherence to payer standards. The structured queues, user management features, and reporting tools ensure a standardized process.

The Bottom Line

Mirra Health Care's Claims Adjudication solution enables healthcare providers to transform their claims adjudication process, driving financial efficiency and unlocking new revenue streams.

Customized for easy integration, this automated system reduces errors, enhances data management, and streamlines patient communication. It standardizes the process, making it consistent and compliant with payer requirements.

You opt for efficiency, accuracy, and an optimized healthcare practice by choosing Mirra's Medicare Advantage in a Box umbrella of solutions. Get in touch with our experts to schedule a demo today.

The Bottom Line

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Reviews & Testimonials


NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

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