How to stay compliant with claims processing
Filing paper-based claims is not only inefficient and time consuming, it can lead to serious human errors.
When it comes to processing claims, there are a number of potential security and compliance traps that could mean serious problems for insurance companies.
Whether it’s HIPAA or TCPA, companies need to stay vigilant when it comes to insurance communications with their customers.
Filing paper-based claims is not only inefficient and time consuming, it can lead to serious human errors. There are a few ways in which companies can use technology to make sure they are on top of the latest compliance requirements — while accelerating the claims management process — to save huge costs
Keep your communications secure and private
It is extremely important to make sure that your communications with your customers and their private information is as secure as possible. HIPAA covers many aspects of protecting patient information. Those working with claims that require an exchange of patient health information (PHI) or personally identifiable information (PII) must pay especially close to Title II, which holds standards on how and with whom patient data can be shared. HIPAA has standardized the requirements for electronic claims processing software.
Ensure claimants have opted in to engage electronically and via phone and texts to be in compliance with national regulatory laws like TCPA (if your claimant is in the U.S.) Each country may have exclusive regulatory requirements that insurance companies need to be aware of while interacting with their claimants electronically using technology like chatbots, but the fundamental objective of these laws is designed to protect privacy for the customer and allow them to opt-in and opt-out of communication methods at their will.
Keep claims accurate and prevent mistakes
When you electronically transfer information, there are a number of advantages over humans handling paperwork and files. Consider a software platform for claim engagements. This will offer a safety net that will keep you from falling out of compliance or making any mistakes.
Manual data entry is fraught with errors because it is repetitive and time consuming. The latest software for processing claims can pull key pieces of information from the unstructured data of emails, PDFs, etc. and automatically structure and populate the data points into your back-end systems. The features of robotic process automation (RPA) that allow data to be handled across many different systems ultimately means fewer human errors and significant time savings.
Conduct electronic audits
With increasing scrutiny of insurance claims processing systems by regulatory agencies and auditors, it is more important than ever for companies to conduct regular audits of their claims processes. Audits can be painstakingly long if you are not using the latest technology.
Here is where the latest software platforms automating a variety of customer engagements can be helpful. RPA and AI technology for example are able to ingest and decipher thousands of claims documents and find holes of missing information or data that humans might have overlooked. As the venture capitalist and entrepreneur Marc Andreessen puts it, “software is eating the world” and if you need to stay relevant, you have to embrace the change.
Finding the right solution
Digitizing your claims processing through an electronic medium is not just the current fashion, but it is great for business. The customer experience is dramatically frictionless. You cut costs by automating many of the steps that you may be currently doing manually. You can catch and prevent more errors, reduce administrative time, and most importantly, protect yourself from potential compliance vulnerabilities.
Have the most sophisticated, advanced system in place so you never wake up to a million dollar lawsuit.
Simha Sadasiva is the co-founder & CEO at Ushur, the first micro-engagement service platform that leverages data and technology to digitally transform back-end processes and conversational interfaces for enterprises in the insurance sector. If you’re interested in learning more about micro-engagements, send email to info@ushur.com.
These opinions are the author’s own.
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