Claims solutions that power profitability

Increased cost pressures, regulatory uncertainty, and membership flux make it difficult to unlock the value of claims data. Abandon the spreadsheets and manage claims code sets, increasing first pass auto-adjudication rates and reducing inaccurate claims.

Wolters Kluwer helps health plans manage claims code sets using a combination of software, data and services, reducing the manual work required to update lists of codes used for reimbursing claims from your provider networks. Up-to-date codes ensures accurate data is being used across your claims operations using the latest updates from the standards bodies.

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Improve claims accuracy with high-quality data

Avoid Lost Revenue

Reduce financial exposure by identifying, recovering and preventing overpaid claims by ensuring your claims systems are leveraging the latest updates provided by CMS and the AMA.

Minimize Manual Reviews

Scale data efforts and manage claims codes using software, reducing errors and administrative costs by providing workflow and collaboration tools to properly approve and update claims codes.

Improve Compliance

Comply with state requirements and ONC regulations that require data access and sharing, while improving data quality that informs decision making.

Reduce Inaccurate Claims

Increase first pass auto-adjudication rates to decrease the processing of inaccurate claims, improving provider satisfaction.

What's at stake for health plans?

  • Up to 60-70% of provider-submitted claims have incomplete or incorrect data

  • There are stiff penalties in some states on claims that take longer than 30 days

  • 1 in 5 medical claims submitted are processed incorrectly, costing up to $15.5 billion in unnecessary administrative expenses

  • An auto-adjudicated claim costs health insurers just cents on the dollar, while one that needs human intervention costs ~$20 per claim