Claims

Challenges with Claims processes can impact efficiency and costs. Typically, claims that aren't automatically processed through existing adjudication systems must be manually worked. This usually happens when a claim falls outside the adjudication system parameters because of missing or duplicate information, or because the nature of the claim requires special handling. In order to complete the claim, the processor must work through the complexities of the regulatory and business constraints. Add to this the confusion of accessing multiple systems to confirm the right data, missing information, and the need for timeliness to process the claim. Organizations face mounting pressures to reduce operational costs, reduce cycle times and increase accuracy - all factors that affect the efficiency of the Pended Claims process.

The IPD Solution
As an out-of-the-box application, Ultera addresses Claims challenges through the use of configurable modules that allow Ultera to adapt to the company’s business needs.

Ultera integrates with most popular enterprise content repositories to store and retrieve documentation needed to speed up decision making in the claims process. Workers can process claims more quickly by using the Ultera application to match new incoming items with existing claims, update the items status and automatically attach the documents together. By enabling work searches across multiple queues, automatic routing of work items, and easy reassignment of work, managing claims is faster and easier with Ultera.

The Ultera Application Engine queues and tracks items as they progress through the claims process, according to a configurable set of rules. This allows easy identification of pending and delayed items, thereby allowing the business to identify and address gaps in the process. Ultera's Reporting Module allows users to see Work in Progress Statistics, Aging, Productivity and Audit information.