Compliance
Regulatory compliance is a key concern to insurers. Some of the most frequently asked questions relating to InHealth and compliance issues follow.
HCAI
Q: How does InHealth’s technology co-exist with HCAI?
A: InHealth’s decision support software provides unparalleled management visibility into claims team performance. Whereas HCAI is focused on collecting information relating to forms, claimants, invoices and approval decisions; InHealth’s focus is optimizing adjudication, decision making and customer service. Once HCAI is implemented, HCAI data will be imported into InHealth to ensure form information is available without redundant data entry. InHealth’s customers' meet HCAI reporting requirements, while still benefiting from process optimization, detailed performance analysis and cost savings only offered by InHealth Claims Intelligence Solution.
Post DAC Determinations
Q: How successful have InHealth’s insurance customers been in achieving approval agreements post DAC – where questionable claims require a TP determination?
A: InHealth Claim Intelligence Solutions case management efforts are successful, tracking results on 1000 forms demonstrates that negotiated agreements are made on 43% of forms submitted with only 15% sent for TP determination.
SABS Mandatory Response
Q: How does InHealth manage compliance with mandatory response timelines?
A: InHealth’s Claim Intelligence Solution automates validation and response on claim forms within seconds of submission thereby eliminating the compliance risk factors.
Q: How is it possible to reach agreements on claims with the mandatory time constraints?
A: InHealth’s Decision Support provides workflow specific informational messages guiding the claims team to quickly reach agreements on more complex cases. For example, response times achieved with InHealth’s Business Process Outsourcing Service Level Agreement (SLA) are:
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