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Claims management inefficiency continues to plague health plans relying on outdated systems. Manual workflows, slow approval processes, and outdated technology often result in delays, errors, and frustration for all those involved.
As claim volumes grow and expectations evolve, traditional systems need to catch up, which leaves health organizations burdened with operational bottlenecks and high costs.
Health plans need modern solutions that simplify processes and improve efficiency. Mirra’s claims management software offers a powerful solution to address these challenges.
It uses cloud technology to make claims processing faster, safer and more scalable. To help health plans provide cost-effective, high-quality services and stay competitive.
Understanding Cloud-Based Claims Management Software
A Cloud-based Claims Management Software operates on a web server rather than traditional on-premises systems. It offers health plans secure, on-demand access to claims data and management tools, enabling smooth real-time collaboration with providers and members while supporting efficient decision-making.
This solution is typically offered as a (Software as a Service) SaaS model where users subscribe to the service rather than making a large investment in hardware and infrastructure.
Key Benefits of Cloud-Based Claims Management Software
Claims Adjudication Software has transformed the way organizations handle insurance claims, providing a wide range of benefits that enhance operational efficiency and reduce costs.
Here's how Cloud-based Claims Management Software transforms the claims process:
Improved Efficiency and Speed
Cloud technology enables members and providers to access claim data from anywhere, promoting real-time collaboration and faster processing. It reduces administrative costs by minimizing manual procedures in Claims Adjudication.
Cost Efficient
Cloud solutions reduce operational costs and allow businesses to scale resources based on demand without large upfront investments in hardware.
Data Security
With advanced cloud data security practices like encryption, access control, data transmission flow, regular security audits, network protection, etc., stakeholders can keep the data safe from threats like data loss, Malware injections, insider threats, etc. in Claims Adjudication.
How does Cloud-Based Software Transform Health Plan Operations?
Mirra’s Cloud-based Claims Adjudication Software has a significant impact on how health plan businesses operate by offering benefits that streamline processes, enhance efficiency, and improve the overall quality of care.
Here’s how it’s making an impact:
Automation of Claims Processing
Claims Management Software automates repetitive tasks like claim assessments, and document management, reducing the reliance on manual labor and minimizing human errors with the help of advanced features like data capture and eligibility verification.
This leads to faster processing times, quicker claim resolutions, and more timely payouts, ultimately improving operational efficiency and reducing the overall cycle time of claims.
Mirra Healthcare uses these two solutions for an effortless processing of claims adjudication.
ClaimsLite: This Simplifies paper claim entries by automating data capture, minimizing errors, and speeding up processing. It converts paper claims into EDI files, with both formats undergoing validation for accuracy.
ClaiMaster: This Streamlines adjudication for CMS-mandated paper and EDI claims, automating tasks like eligibility checks, benefit applications, and payment calculations to reduce manual effort.
Centralized Data Management
Mirra’s Claim Adjudication software unifies all claim-related data into one centralized platform called ClaiMaster and creates a single source of truth. This allows all stakeholders- payer, provider, and member --to access accurate and up-to-date information in real-time.
By centralizing data storage capabilities, it reduces discrepancies while improving consistency and reliability throughout the claims process.
Improved User Experience
With the help of Mirra’s Utilization Management tool, Calypso Lite, health plans can deliver better experiences across their ecosystem in the following ways:
Authorization Management
- Streamline approvals/denials
- Enable real-time authorization status updates
- Maintain compliance with CMS/NCQA standards
Operational Efficiency
- Access user-friendly queues with summary tabs for real-time tracking
- Utilize Smart Assign for optimal workload distribution
- Generate automated member and provider notifications
- Integrate seamlessly with existing systems through APIs
Compliance & Reporting
- Track authorization turnaround times (TAT)
- Access comprehensive dashboards
- Generate CMS audit reports including EOD and SOD universes
Also, read 4 Ways Health Plans Can Improve Member Satisfaction Through Claims Processing
Common Concerns and Solutions
Implementing new Claims Management Software can be a complex process for health plans with concerns ranging from integration to cost management.
Mirra, a third-party administrator in Florida, designed its Claims Management Software to address these challenges by offering a streamlined implementation plan, customized strategies, and continuous support. This section highlights common concerns and their solutions:
1. Data Security and Privacy
Concern: Risk of sensitive data breaches or non-compliance with regulations.
Solution: Implement advanced encryption, multi-factor authentication, and regular compliance audits (e.g., HIPAA, GDPR).
2. Integration with Existing Systems
Concern: Compatibility with legacy systems or other third-party software.
Solution: Mirra’s Claims Adjudication Software provides flexible APIs and seamless integration capabilities.
3. Learning Curve and Adoption
Concern: Resistance to change or difficulty in transitioning.
Solution: Mirra’s Support team provides intuitive interfaces, comprehensive training, and ongoing support.
4. Cost Management
Concern: Hidden fees or escalating subscription costs.
Solution: At Mirra, you get transparent pricing models and scalable plans customized to your needs. Also, read 4 Ways Effective Claims Adjudication Can Control Healthcare Costs
Steps for Transitioning to Cloud-Based Claims Management Software
Here is a step-by-step guide for adopting Cloud-based Claims Management.
Step 1: Assessment and Planning
1. A comprehensive review of the current claims adjudication process is essential, focusing on identifying bottlenecks and areas for improvement within the existing system.
2. Relevant operational data, including workflow metrics and system performance, need to be provided.
3. Post which a detailed diagnostic report, pinpointing areas for optimization and a detailed action plan will be shared.
Step 2: Customized Strategy Development
1. A detailed evaluation of the current system will be carried out to identify key pain points and align with the health plan’s success goals.
2. Following this analysis, a customized roadmap will be crafted, including specific KPIs such as enhanced processing times and reduced error rates.
3. Regular check-ins will be conducted to ensure ongoing alignment and facilitate necessary adjustments as needed.
Step 3: Effortless Integration
1. Mirra's solution will be seamlessly integrated into existing systems, minimizing disruption to operations.
2. Rigorous integration testing will be conducted in a controlled environment to identify and address any compatibility issues before full implementation.
Step 4: Comprehensive Training
1. Comprehensive training will be provided to staff, including role-specific instruction, utilizing step-by-step guides and live demonstrations.
2. Mirra's Customer Support will be available throughout the setup phase and beyond to handle any questions or issues that arise
Step 5: Monitoring and Continuous Ongoing Support
1. A monitoring system will be employed to track the KPIs metrics post-implementation.
2. Mirra's solution will analyze the collected data to enhance functionality and ensure compliance for improvement and optimization.
Conclusion
Traditional claims management is severely hampering the efficiency and effectiveness of today's health plans.
These legacy systems lead to significant delays in claim processing, increased administrative costs, heightened security risks, and frequent errors resulting in claim denials. This ultimately impacts member care and satisfaction.
overcome these challenges and unlock the full potential of their operations, health plans need a modern, cloud-based approach to claims management.
Mirra's Claims Management Solutions offer health plans a revolutionary opportunity to overcome inefficiencies and challenges associated with outdated systems.
Health plans that use cloud technology can streamline operations, enhance data security, reduce costs, and simplify claims processing processes while improving overall claims administration. With latest technological advancement like:
Automation & AI: Implementation of AI-powered solutions like NLP to automate routine tasks, such as data entry, eligibility checks, and prior authorization requests, significantly reducing manual effort and processing time.
Cloud Security: Utilize the robust security measures and compliance frameworks offered by leading cloud providers, such as HIPAA-compliant infrastructure and data encryption, to safeguard sensitive member information.
Blockchain Technology: Blockchain solutions are used for enhanced data security and transparency, ensuring the immutability and traceability of medical records and claims transactions.
Healthcare plans can significantly improve the speed, accuracy, and efficiency of their claims resolution processes, improving the overall member experience.
Schedule a demo to see how our Cloud-based Claims Management Solution can boost your efficiency and accuracy.
