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Dive into the pivotal role of claims accuracy and the value it brings to payers, providers, and members alike. At its core, modernizing healthcare claims operations centers on a well-coordinated strategy that combines out-of-network considerations with payment integrity components, creating a comprehensive approach that ensures accurate claims processing and timely payments.
Inaccurate claims, a thorn in the side of the healthcare industry, not only inflates costs but also escalates administrative burdens. Another challenge is the impact of inflation on the cost of goods and supplies to providers who are seeking ways to offset revenue losses. Complex payment processes and systems, competing priorities, and discrepancies between adjudication platforms further compound these challenges.
A coordinated approach can mitigate these challenges and generate savings that can be reinvested into member benefits and operational efficiencies. This whitepaper guides Blues plans stakeholders through the challenges, benefits, and best practices for routing claims through optimal savings channels.