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How Can Automation Transform the Claims Adjudication Process

09 Jan, 20242:30 PM

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How Can Automation Transform the Claims Adjudication Process

Efficient and accurate healthcare claims processing is essential for achieving optimal healthcare performance and success. With denial rates posing a significant challenge in the claims process, there is a need for a swift and effective solution. Embracing healthcare claims automation emerges as this transformative solution.

Automation ensures precision and productivity while helping healthcare businesses navigate claims seamlessly, minimize errors, and significantly improve operational productivity.

And this is precisely what Mirra's Claims Adjudication solution does. It's a strategic asset that addresses rising denial rates, drives operational excellence, and ensures consistent revenue streams.

In this blog post, we will share how automation acts as an essential component of the claims adjudication process for both payers and providers. So, let's get started. Read on.

Current Challenges in Healthcare Claims Management

The following are some of the most pressing challenges facing the healthcare claims management landscape:

  1. Escalating Denial Rates: Providers face denial rates nearing 20%, causing substantial financial challenges—problems in coding, eligibility, and documentation cause these denials.
  2. Manual Processes' Limitations: Labor-intensive manual procedures result in errors, inefficiencies, and delays. These processes strain resources and disrupt revenue cycles.
  3. Stringent Regulatory Requirements: Evolving regulations demand rigorous compliance, complicating healthcare claims management and increasing administrative burdens.
  4. Data Discrepancies: Disconnected data sources and formats hinder seamless integration, leading to inaccuracies in TPA claims submissions.

These challenges significantly impact operations and profitability.

Understanding Mirra's Automated Claims Adjudication Solution

Mirra's Claims Adjudication Solution is an advanced system designed to streamline and digitize the healthcare claims management process. It offers capabilities that facilitate seamless transitions from paper-based claims to digital records while efficiently handling electronic claims. This robust solution is a comprehensive reimbursement system, ensuring swift and accurate payment processing.

Key Benefits

key benefits

For Payers:

  • Customized Solution: Mirra's solution is tailored for easy integration and handling, offering customized settings aligned with distinct healthcare provider requirements.
  • Error Reduction: The system significantly minimizes errors compared to manual intervention, ensuring precise and reliable TPA claims processing.
  • Cost-Efficiency: By reducing administrative costs associated with pending claims, Mirra's solution optimizes financial resources for healthcare providers.
  • Accelerated Turnaround Time: Providers experience expedited payments as Mirra's solution improves the overall turnaround time, expediting claim processing.
  • Automated Processing: Mirra's system seamlessly handles medical, institutional, and dental claims, automating the processing and minimizing the need for manual intervention.
For Providers:

  • Seamless Integration: Mirra's solution integrates smoothly with provider systems, offering tools that support providers' administrative needs and workflows.
  • Enhanced Accuracy: The system minimizes errors and improves the accuracy of claims processing, ensuring reliable reimbursement for healthcare providers.
  • Operational Efficiency: By reducing administrative burdens, Mirra's solution frees up resources and enables providers to focus on delivering quality patient care.
  • Faster Payments: Providers experience expedited payments as Mirra's solution improves the overall claims processing time, enhancing cash flow.
  • Streamlined Workflow: Mirra's automated processing capabilities reduce manual tasks and improve efficiency across the claims adjudication process for providers.
key benefits

Mirra’s Claims Adjudication Solution’s Advanced Features at a Glance

  • Account Management: View client AR ledgers, claim details, service information, provider details, edits, documents, notes, maximum out-of-pocket (MOOP), activity logs, and more.
  • File and Queue Management: Effortlessly manage files, upload various documents, encounter files, and categorize TPA claims into specific queues for streamlined processing.
  • Comprehensive Reporting: Access SSRS/Power BI reports and scheduled reports, providing valuable insights into healthcare claims management and processing.
  • Member and User Management: Easily search and manage members, handle prior authorizations, generate various letters such as explanations of benefits/payments, rejected letters, and more.

Recent industry stats reflect a 5-15% annual surge in claim denials, necessitating innovative, automated solutions for streamlined and error-free claims adjudication.

Why Choose Mirra's Claims Adjudication Solution?

When we talk about Mirra's solution, it stands out because it offers an ideal platform for different plan types, ensuring a high auto-adjudication rate and significantly improving the quality and timeliness of claims processing. The system's flexibility in configuration allows seamless processing of varied benefits with high auto-adjudication rates. It also includes built-in automatic quality checks, high-dollar reviews, and extensive editing software to review claims for potential fraud, waste, or abuse.

Innovative Products for Seamless Integration:

Mirra offers futuristic and cost-effective products, ClaimsLite® and ClaiMaster®, easily integrable with third-party gateways. ClaimsLite® facilitates the entry of paper claims, while ClaiMaster® specializes in adjudicating EDI claims mandated by the Centers for Medicare and Medicaid Services (CMS). These products include built-in claims editing software with over 40 million edits, integrated prices, and thorough checks to ensure accurate claims processing.

Impact on Staff Productivity and Resource Allocation

Implementing Mirra's Automated Claims Adjudication Solution significantly alleviates the operational burden on healthcare staff, substantially enhancing productivity.

Heightened Productivity

The solution effectively tackles laborious administrative tasks through streamlined automation, allowing staff to concentrate on more critical aspects of healthcare provision. Integrating Mirra's solution has improved staff efficiency by minimizing time-consuming manual processes. This shift has led to a notable increase in staff productivity, ensuring their focus remains on delivering quality care instead of administrative complexities.

Enhanced Resource Management

The implementation of Mirra's solution optimizes resource allocation within healthcare facilities. By automating numerous administrative functions effectively, staff can dedicate more time to patient-centric activities, enhancing the overall quality of healthcare services.

Realizing Operational Efficiency

Adopting Mirra's Automated Claims Adjudication Solution results in streamlined operations, enabling healthcare providers to channel their resources more effectively towards delivering superior patient care. The optimization of staff efforts facilitates a more patient-centric approach while maintaining operational efficiency in the healthcare ecosystem.

key benefits

Financial Implications and Revenue Enhancement with Mirra's Solution

The implementation of Mirra's Automated Claims Adjudication Solution not only optimizes operational workflows but also yields substantial financial benefits for healthcare providers. The system's precision in processing claims and its reduced error rates significantly impact the economic landscape within healthcare organizations.

Enhanced Cost Efficiency

Mirra's solution minimizes administrative costs related to claims processing. Reducing manual interventions and streamlining operations mitigates the overhead expenses associated with error corrections, rework, and extended processing times. This efficiency boost translates into substantial cost savings for healthcare providers, enhancing their financial health.

Revenue Acceleration

The automation's swift processing capability expedites the claims adjudication process. With fewer pending claims and a faster turnaround time, Mirra's solution accelerates revenue cycles for healthcare providers. More secured claim approvals mean quicker reimbursement, positively impacting cash flow and overall revenue generation.

Improved Return on Investment (ROI)

The implementation of Mirra's solution represents a significant return on investment. Reducing administrative costs and increased efficiency and accuracy in claims processing results in an impressive ROI for healthcare organizations. Moreover, the solution's seamless integration minimizes additional technology-related expenses, augmenting its overall financial benefits.

Concrete Financial Gains

Mirra's Automated Claims Adjudication Solution offers a tangible impact on the financial front. Through its cost efficiencies, accelerated revenue cycles, and substantial ROI, healthcare providers significantly improve their financial standing, reinforcing the value proposition of Mirra's automation within the healthcare ecosystem.

Enhancing Patient Experience Through Mirra's Automation

The following are some ways in which Mirra's automated claims adjudication solution enhances patient experience:

  • Enhanced Information Accuracy: Ensures precise patient data management, minimizing errors and ensuring consistent, reliable information across all touchpoints. Improves personalization and tailoring of healthcare services.
  • Empowering Patient Engagement: Facilitates proactive communication, providing automated updates on claim status, billing, and appointments. Empowering patients with timely information fosters involvement and trust in their healthcare journey.
  • Streamlined Administrative Processes: It increases efficiency, reducing wait times and expediting service delivery. Automation allows stakeholders to focus on quality care, ensuring quicker responses and minimizing administrative bottlenecks.

The Bottom Line

Mirra's Claims Adjudication Solution is a versatile and transformative tool that optimizes the claims adjudication process for both payers and providers. By leveraging automation, Mirra empowers healthcare organizations to streamline operations, reduce errors, and enhance financial performance. Whether you are a payer or a provider, Mirra's customized solution delivers accuracy, efficiency, and cost savings to support your healthcare journey. Reach out to us for a custom demo.

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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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