Today, there are two ways to get insurance verification automation solutions: you can either build them yourself or partner with someone who is an expert at providing insurance card capture and verification automation related solutions. It is crucial for healthcare organizations to have an automated insurance card capture system as the cost of insurance errors and denials can impact healthcare greatly.
We experience more than $260 billion in insurance denials every year with more than $30 per lost claim as additional expenses. In fact, 65% of denied claims are never revoked even though 66% are recoverable. Existing options for insurance capture, such as paper and clipboard, digital intake, and OCR (optical character recognition) intake, have great potential to become better. Older systems can help with card intake, image processing, and extraction processes, but they are unable to accurately identify payers and plans from images, provide insurance benefit verification, identify COB (Coordination of Benefits), and more. Now is the time to pursue a modern solution and replace the outdated software and processes.
Building AI-enabled insurance capture and verification systems have a cost of ownership that includes infrastructure, team members, maintenance, and training costs as well as technical and knowledge requirements. Changing the payers and plans landscape also requires a team to consistently update new payer pans and mappings while retraining the AI model to accommodate the changes. However, this option comes with risks such as high upfront costs, high lifetime costs, time delays, and maintaining credibility. Nonetheless, this option allows you to have complete ownership of the insurance card capture system and create your own specific workflows. Building a system means you have capital expenditures and development for many years.
If building is not an option, buying insurance card capture systems can make more sense. The costs include API subscriptions and transactions and include a partner fit risk but provides you with a dedicated team, low overall costs, lack of delays, and simplicity in its usage. Automating insurance card capture and verification can help many healthcare organizations save on current costs while providing better experiences to patients.
Source: Orbit Healthcare
