In a previous post, we looked at ways an integrated claims management solution—one that includes multiple integration and workflow automation options—can transform claims administration processes. But you don't have to be a self-administered organization to benefit from claims management functionality in a RMIS. The following features are just a few examples of how such a solution can help you consolidate all of your organization’s claims data in a single system, streamline workflow processes, and perform analysis that contributes to more informed decision-making and improved claim outcomes.
Consolidating data
Data Update Tools and Services
RMIS systems simplify the collection of claims, transactions, and supplemental claims-related information by providing update tools and services that allow for the import of data from carriers and TPAs. Secure daily, quarterly, or monthly feeds can be scheduled based on your needs. A cloud-based RMIS like Origami Risk also provides on-screen tools for easily importing data from spreadsheets, as well as for encrypting and exporting via FTP.
Third-Party System Integrations
Integrating a RMIS with third-party systems can help to break down silos of data, reduce the strain on resources, and eliminate error-prone rekeying of data from disparate systems. Origami Risk seamlessly integrates with third-party software, allowing for the secure exchange of data between HR, accounting, and payroll applications and systems used by medical billing and nurse case management providers.
Streamlining processes
Document Management
Put an end to time wasted on looking for documentation by making it easier to find critical files and move toward a paperless environment by centralizing storage of claims-related documentation. Within Origami Risk you can attach scanned versions of paper documents to any record in the system, email file attachments directly to claim records, view documents by selecting from a list of recently opened files, or search across all files in the system by specific words or phrases.
Automated Workflows
Time is what everyone needs more of. Workflow tools can free staff from repetitive, time-consuming activities associated with claims management can automate processes, standardize procedures, and increase efficiency from claim inception to final payment. In Origami Risk, any event—for example, initial claim entry, changes made to claim details, or payments and reserves that exceed defined thresholds—can trigger the generation of alerts, communications, and the routing of financial approvals.
Analyzing data
Analytics and Benchmarking
Integrated analytics and benchmarking can help to make claims analysis straightforward and fast. For example, in Origami Risk, the Claims Comparison Report pulls data elements from a claim, compares it to similar claims in the system, and displays the results on a scatter chart, making it easier to gauge where a claim stands when compared to similar claims in the system. Also shown is the claim and related claims with a standard deviation, above and below. ODG integration within Origami Risk provides direct access to return-to-work guidelines and benchmarks a claim against a dataset of more than 10 million lost-time cases. Claims are scored based on projected severity, making it easier to identify claims that require early intervention.
Dashboards and Reports
Dashboards and reports help to visualize claims data, providing key insights that can be used to make informed decisions and an effective means for demonstrating success. Origami Risk provides access to more than 100 standard report, graph, and dashboard templates that can be adjusted based on specific needs. Reports can be scheduled for automatic distribution to stakeholders. Dashboards can be tailored, and shared, based on role or location to provide useful views of claims management activities and outcomes.
An integrated claims management solution that combines data consolidation and workflow automation tools with intuitive reporting and analysis are the foundation for transforming your approach to managing claims. Origami Risk is a scalable, cloud-based platform that includes all of the functionality required for the end-to-end handling of claims across all lines of coverage, combined with virtually limitless integration and workflow automation options.
See how Banner Health used automation tools to streamline workflows and drive efficiencies in claims management operations. To download the case study, click here.