HealthMay 19, 2021

The critical role of reference data for effective claims processing

Experts estimate 1 in 5 medical claims submitted to health insurers are processed incorrectly, costing up to $15.5 billion in unnecessary administrative expenses annually.

While there are a variety of reasons for these issues, one of the most pervasive is poor code set data quality and consistency within payer organizations.

While health plans are working hard to enable automated information exchange between providers and other healthcare stakeholders, the lack of semantic interoperability between internal IT systems remains a major challenge. This has lead to enduring operational issues within the claims processing workflow that lowers their auto-adjudication rates and increases claim delays.

Health plans must implement a strong, enterprise-wide reference data management strategy that allows common meaning to be derived from different systems, processes, and stakeholders.

Learn how a comprehensive reference data management strategy can optimize and improve the following within the claims processing workflow:

  • Content updates
  • Resource allocation
  • Provider satisfaction
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Health Language Data Interoperability
Manage and maintain your enterprise healthcare data in a single platform for authoring, modeling, and mapping to industry standards to enable semantic interoperability.
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