MetaSource's Diligence and Agility was Just What the Doctor Ordered

Client Background

A National Health Plan operating with a network of over 15,000 physicians and other health care professionals has consistently been named one of the nation’s top-ranked health plans for quality and member satisfaction.

Challenges and Requirements

Significant cost overruns and an executive mandate to reduce costs in all operational areas prompted this National Healthcare Plan and Physician Network to investigate ways to optimize its claims processing procedures.

The MetaSource Solution

MetaSource was able to work with this client to very quickly identify key areas for immediate improvement which would result in reducing claims processing costs and increasing auto-adjudication rates. MetaSource implemented a fully integrated mailroom and adjudication program in short order that included receipt, opening, scanning, data capture, error resolution, and benefit related table-driven knowledge processing tasks. MetaSource also implemented an image and workflow system that has provided immediate access to claim documentation and significant in-house adjudication efficiencies.

The Result

• Reduced per-claim processing costs by 65%
• 60% improvement in first-pass adjudication rates - decreasing manual intervention and enhancing claims payment accuracy
• Improved access to critical documents

We Can Help

Find out how MetaSource can help your business optimize your claim processing procedures, and deliver on reducing costs.