HealthDecember 14, 2020

Wolters Kluwer helps health plans implement more accurate and timely claims processing

Wolters Kluwer, Health announced today that it has launched a new solution for health insurance plans to dramatically improve the accuracy and timeliness of claims processing while reducing physician abrasion.

The Health Language solution, Reference Data Management (RDM) For Claims Processing, combines deep domain expertise with tools to overcome pain points related to managing code sets. Tailored for health plans, the solution specifically keeps claims processing systems up to date while strengthening pre-payment integrity and claims processing at the line-item level.

“We have learned a lot about important use cases from our growing base of reference data management customers and we’re putting that expertise and insight to work,” said Karen Kobelski, Vice President and General Manager, Clinical Surveillance, Compliance & Data Solutions at Wolters Kluwer, Health. “For healthcare plan claims processing, we harnessed a set of Health Language capabilities that, together, address challenges payors face with remediating claims coding changes. We will continue to take a fresh look at our customers’ challenges to see how combining our tools in new ways can deliver maximum value for them.”

The four components of RDM For Claims Processing include:

  • Code sets: Suite of standard and Health Language proprietary code sets that are automatically updated to ensure claims processing systems are always accurate
  • Payment integrity: Pre-authorization rules match claim line detail adjudication to deny line items not associated with the authorized procedure and avoid costly pended claims
  • Fee schedules: A single source for accurate pricing aligned with contracts
  • Claims adjudication and EOB content: Member friendly code descriptions for regulatory compliance, member engagement, and reduced call center traffic

Designed to centralize vast amounts of siloed data and improve operational efficiencies, the new Health Language solution from Wolters Kluwer empowers health plans to improve claim accuracy and turnaround time, optimize reimbursement and reduce provider abrasion by ensuring payments are paid accurately the first time. For example, these added tools also support health plans’ broader efforts to relieve providers’ administrative loads and reduce delays that can impact care during the coronavirus pandemic.

This release is the first of several RDM bundled solutions from the company. Please visit our site to learn more about our reference data management solutions.

Explore Reference Data Management
About Wolters Kluwer

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory , and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

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