5 Top Questions to Effectively Evaluate a Claims Management Solution

In 2023, more than 50% of healthcare providers said the number of denied claims rose for their organizations, most often due to errors in registration, lack of documentation and missing or incorrect patient information.

As denied claims rise, finding the best solution to manage these issues will be top-of-mind for leaders. But evaluating various claims management solutions can be difficult and time-consuming with so many options available.

To streamline the process and ensure your team identifies the best solution for its needs, consider these top five questions to ask each vendor.

1. Is it customizable?

No two healthcare organizations are the same. So, when it comes to finding the right claims management solution, a generic option isn't likely to meet your team's unique needs.

It’s crucial to have claims management technology that allows you to create custom data fields, modify reports and manipulate files easily. As your organization expands or your priorities shift, will your claims solution also adapt to these changing requirements or new business segments?

2. Can the solution integrate with other systems?

Claims management software is designed to make the claims process more efficient. But if the solution doesn’t integrate well with other systems, it can actually slow things down.

To avoid this frustration, ensure the claims management solution you’re considering is compatible with other technology already in place at your organization.

Can the solution effectively communicate and exchange or utilize data within your specific technology environment? Ideally, the claims solution should be flexible enough to integrate with different systems for better claims processing and issue resolution.

RELATED: Revolutionizing Claims Management Through Robotic Process Automation

3. How is the customer support?

The quality of any product is important, but the quality of customer support can be the difference between a positive or negative experience. The same applies to a claims management solution.

Your team isn’t just using a product, but rather you should be entering a strategic partnership with a third party. If product issues arise, you need to be confident that the vendor will be there to help minimize any negative impact and work quickly to find a solution. A reputable vendor should offer thorough documentation and expert customer service.

4. Does it simplify the claims process for you?

Several claims management vendors solely function as standalone claims scrubbers, which can only complicate claims adjudication and status updates.

However, a claims vendor that operates its own clearinghouse offers additional benefits. For example, they can manage payer relationships, provide reconciliation reports to confirm receipt of all your claims and resolve inconsistencies across payer 835 files for cash posting.

Most importantly, these vendors can actively engage with payers on your behalf to challenge incorrect rejections, ensuring expedited payment and improved compliance.

5. Is it secure?

More than 93 percent of healthcare organizations have experienced a data breach over the past three years, with 57 percent having had more than five data breaches during the same time frame. With many organizations vulnerable to a cyberattack, it’s imperative the vendors you partner with comply with the industry’s highest security standards.

During the evaluation process, find out what certifications (e.g., HITRUST) or additional measures the claims technology vendor is taking to safeguard data and ensure it remains accessible only to authorized users.

Be armed with relevant information to ensure you're able to make an educated decision when purchasing a claims management solution. Download our buyer's guide for a complete list of questions to ask and additional insights to aid you throughout the evaluation process.