CLAIMS BACKLOG

2-Step Approach to Eliminating Confusion Behind Claims Backlog

As a healthcare payer or TPA, you know that claims processing when its working right feels like a well-oiled machine, but a backlog of claims can lead to delayed payments, frustrated providers, and unhappy members. Fortunately, we have a results-driven 2-step approach that has significantly improved our clients efficiency in managing claims backlog. In this blog post, we’ll share this approach, highlighting the benefits and drawbacks, and how this transformative system has fundamentally changed our client’s claims processing for the better.

Step 1: Workforce Preparedness

One of the critical components of successfully eliminating a claims backlog is ensuring that your workforce is properly prepared and trained. In our experience, investing time and resources into workforce training has reaped tremendous benefits for claims teams.

Benefits:

• Increased Knowledge & Skillset: Team members become more proficient in handling claims thereby increasing their overall productivity. This increased knowledge also leads to fewer errors in claims processing.
• Improved Confidence & Morale: A team’s confidence will soar as they better understand their role in the claims process. This newfound confidence leads to an increase in job satisfaction and overall morale.
• Cost Savings: A well-trained workforce can lead to cost savings by reducing error rates and increasing processing speed, leading to faster turnarounds on claim payments and fewer provider disputes.

Drawbacks:

• Time & Resource Investment: Staff training can be time and resource-intensive. It is essential to plan and allocate resources effectively to balance the training investment with the returns.

Step 2: Tool Implementation

Equipping your team with the right tools is crucial to efficiently managing the claims backlog. After evaluating numerous solutions, CMP has found a few tools that have made a significant impact on increasing claims processing efficiency.

Benefits:

• Automation: Several of the tools implemented have automated redundant and time-consuming tasks, freeing up valuable time for teams to handle more complex issues.
• Improved Accuracy: With the right tools, teams will experience a reduction in human error. This improvement leads to more accurate claims processing and fewer time-consuming disputes.
• Streamlined Workflows: Toolkits enable the creation of more effective workflows, helping claims flow smoothly from one stage to the next and allowing teams to work more efficiently.

Drawbacks:

• Initial Setup/Costs: Some tools may have a steep learning curve or high upfront costs. However, we’ve found that the long-term efficiency gains and cost savings outweigh these initial challenges.
• Ongoing Maintenance: Like any other technology solution, these tools need ongoing maintenance and updates to continue functioning optimally. It’s essential to allocate resources and personnel for this aspect to the tool’s long-term success.

When you partner with Clarity Performance Solutions, we supply your team with the training and tools they need to succeed. And in return, your claims backlog can be eliminated.

Conclusion

Our 2-step approach of workforce preparedness combined with the implementation of the right tools can make a significant impact your team’s ability to quickly and efficiently eliminate confusing claims backlog. While there have been a few drawbacks and challenges encountered along the way, we genuinely believe that the benefits far outweigh these obstacles. Clarity Performance Solutions would highly recommend this approach to any healthcare payers or TPAs seeking to improve their claims processing speed and effectiveness.