How Much Automation is Too Much?

 
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As technology advances and your business continues to grow, how do you handle the additional workload? Healthcare payers need automation to handle the increasing volume of claims in compliance with ever-expanding regulatory control. Dealing with such vast quantities of data each day requires consistency in claims processing and automation across a wide array of fronts. With demands for compliance, yet the pressure to keep administrative costs low, the headlong rush to automate continues. The real question is, how much automation is too much?

With the power of SpyGlass, you decide.

Through dynamic, easy-to-use controls, across a wide range of areas, SpyGlass give you the ability to determine how much automation is right for your organization. Each day, the powerful automation tools within SpyGlass process thousands of claims automatically. As part of Beacon’s effort to help customers reach higher auto-adjudication rates, we have created options for a variety of automation areas that give you the controls you want in each specific area.

For example, in member and patient match areas, SpyGlass allows users to define match and confirm criteria to help determine whether a member match is strong enough to allow claims for that member or patient to be auto-adjudicated. If a member has not filed the required verification of coordinating coverage documents within a six-month time frame, for instance, SpyGlass offers the ability to pend the claim to a user-defined workflow queue, along with a remark code of your choosing, like "COB Verification is Out of Date." This allows you to automate when possible, and not to automate when you're uncertain on a critical data point.

Even when you do get a great member and patient match, you may want to pend certain kinds of claims to a specified workflow for manual review. Although you might have a threshold to pend all claims over $5,000 in payable charges, you might want to pend claims of a certain kind with a lower threshold. Chiropractic claims over $400 might be worth pending just because it's an unusually high amount for that type of claim.

Here's another point of intelligent automation. If you have an automated accident inquiry letter set to go out any time you receive a claim marked as an accident or with an accident code on it, you might want to impose a quiet period for the same letter for a fixed period. If you don't have a quiet period set, your members and patients might get 10 letters generated if the accident itself generates 10 different claims. The wasted paper, expense, and effort will really seem monumental to people receiving those extra, unneeded letters.

SpyGlass can help improve performance and increase administrative efficiency in a variety of ways, including quicker claims and eligibility import/export, dynamic correspondence, and real-time reporting tools. For automated reports and other scheduling needs, we support handy items such as “the first Monday of every month” or “the last business day of the month,” in addition to typical things like the first day of the month. Little things like this can really add up to make meaningful differences. 

The work of automation is not just about dramatically high auto-adjudication rates, but the flexible, intelligent automation of key processes that also support a wide range of variability. With SpyGlass, ultimately, you decide how much automation is right for your business.


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