High Alpha Ideas

Streamlining Healthcare Claims Exceptions

A major expense for healthcare insurance companies is the processing of healthcare claims, the requests for payment submitted when we go to the doctor. Decades-old technology automatically processes most of those claims, but there is sometimes an exception: a “claims exception,” to be exact. A claims exception is when a claim has not been accepted for payment by the payer (usually an insurance company) due to specific issues or discrepancies, including incorrect payment information, expired insurance policies, coding errors, or if services aren’t covered. The adjudication of exceptions is an incredibly manual and very expensive process. New technology could significantly reduce this cost and help insurance companies manage compliance.