For many members who see a healthcare provider, health insurance is a necessity for its members. However, on the provider end, billing health insurance can be a tricky process. Consequently, around $30 – $71 are lost per claim, or a total of $262 in insurance denials annually. Even worse, 65% of denied claims are never reworked, even though around 43% are recoverable. So why are these numbers so high?
A lot of it can be attributed to the way that insurance information is captured currently. The oldest method used for over a century is the traditional paper and clipboard. Although technically reliable, it requires manual labor and often sees a significant degree of human error. In fact, around 1 in every 25 claims contains an error in the insurance capture.
Similarly, digital intake of insurance information has a similar flaw. However, digital intake is also extremely time extensive. It is estimated that digital insurance capture takes around 5 hours every week, which equates to 260 hours or 6.5 work weeks annually. Also, it suffers from the same human error as the paper and clipboard.
Optical Character Recognition (OCR) is the newest insurance capture technology. While it solves the human error and time-intensive nature of the previous 2 methods, its infancy is also a problem. It only sees around 60% success rate for properly detecting insurance information.
Regardless of the traditional method, they all suffer similar flaws. They are only able to accept physical cards and are able to process basic images only. When it comes to advanced functions like insurance benefit verification or identifying coordination of benefits, these machines falter. Other things like identifying payers and plans from images, validating the accuracy of a payer, and mapping the payer are far beyond the traditional technology.
So, what can be done? Simply put, you need a more advanced system. You can elect to create and customize your own system to keep up, which requires an upfront cost. You can also partner with insurance capture and benefit verification automation technology, which requires a strong partnership with the vendor.
For the former approach, you need a large sum of capital and a long period to go from designing to implementing a system. After implementation, you also need an IT team to maintain, update, and operate the system. This means you need to pay the IT team as well as any training and skills they may need. On the other hand, you could simply lease a system that is tested and maintained by an external IT team. While this is much cheaper and simpler, you lose the uniqueness and customizability of having your own insurance capture system.
Fortunately, Orbit has systems that combine the best aspects of custom-built with vendor-purchased. Orbit offers a 98.5% payer identification rate and accepts printed ID cards, screenshots from phones, digital wallets, and more. They also validate, verify, and map payer and plan information in real time. Whether you want to responsively validate payer information or to have flexibility when accepting insurance ID cards, Orbit has a way to provide value to your business.
