Industry Trends

Although Healthcare Payers have made significant investments in technology and business processes to improve the auto-adjudication or the 'first pass' rate, to minimize intervention by claim analysts, significant percentage of claims still require adjustments and manual adjudication. Moreover high level of auto-adjudication desensitizes claims edits and fails to recognize benefit variations and may result in high amount of claims requiring post payment adjustments.

With the advent of Consumer Driven Health Plans (CDHP), where the health plans are customized for the individual subscribers, the Healthcare Payer industry is wary of a high auto-adjudication rate.

How Wipro Helps

Wipro’s Claim Management solutions enable efficient claims processing ensuring faster settlement cycles for the benefit of members and lowers processing cost per claim benefiting Healthcare Payers.

The seamless integration into existing claim flows and the application of intelligent, rules-based pre-adjudication and routing logic results in higher first-pass rates, reductions in manual handling, and significant financial savings from streamlined claims administration.

Wipro is handling healthcare claims processing of the world’s largest Healthcare Payer and end-to-end processing of healthcare transactions of a large US state government.

Our continued excellence in delivering business value has led to a substantial increase in workload and complexity of work where we now handle high dollar value and complex healthcare and insurance claims processing for our existing clients. Wipro handles manual adjudication of all kinds, including mental and behavioral therapies, large and small employee groups, Medicare, Medicaid, outpatient, inpatient and surgery claims. Wipro has been able to improve productivity by 120% in the processes handled and has significantly reduced the cycle time between claim submission to payment and adjustments.

With innovative claims process management, Wipro has been able to manage the inventory and maintain a claims backlog of less than 10 days and has consistently achieved superlative accuracies in claim payment accuracy.