Solutions

Claims Intelligence Overview

Faster, Better Decisions with InHealth Claims Intelligence Software
InHealth’s unique Claims Intelligence Software enables claims teams to gain greater control over the consistency, quality and speed of claims processing. InHealth streamlines the core business processes surrounding claims processes to reduce costs while providing powerful decision support to improve customer satisfaction. InHealth seamlessly integrates with your existing claims management and HCAI to quicken your time to benefit while respecting existing infrastructure and regulatory requirements.

• Configurable Workflow supporting Best Practices
  InHealth’s Claims Intelligence Software ensures consistency and centralization of form-related claims information and promotes quality claim governance practices. The software’s configurable workflow supports each unique organization's needs, while supporting best practice methodologies developed over decades of processing claims for insurers. Not only does electronic form management increase accuracy, but it also increases the speed with which claims can be assessed and processed, freeing up adjusters' valuable time. Validation of field data within single forms and across related forms ensures that all the required data is in place to properly process a form.
  
  
• Automated Decisions
  InHealth’s unique rules-based engine provides form validation and workflow driven outcomes on a per form basis, automating decision support for 100% of the forms that are the key cost drivers to the accident benefit process. InHealth offers automated decision support to expedite the processing so adjusters can focus more time on complex cases. This extremely powerful tool is unique in the industry, providing insurers with unprecedented productivity gains in claims departments upon implementation.
  
  After form validation, administrators can transfer selected approvals to HCAI and automatically generate notifications.
  
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• Searchable Knowledgebase providing Expert Knowledge and Experience
  When it comes to claims processing, every insurer would ideally have a claims team with expert knowledge and the experience to back it up. InHealth’s Knowledgebase levels the playing field for adjusters by providing each individual with access to the same information, information that has been aggregated by experts over years of processing claims.  The InHealth Knowledgebase is a key component to the forms validation process  providing critical support to the claims team where they often lack time and/or in-depth knowledge for complex claims. This expert benchmark information not only speeds and improves the quality of decisions; it provides a level of consistency and predictability around claims decisions.
  
  Multiple rule sets perform validation checks across forms and claims, guiding the user with recommended actions.
  
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• Custom Portal
  Each InHealth customer will be able to interact with the solution through its own custom, Web-based portal. This portal is a unified interface, featuring connections to both the InHealth solution and your own claims management systems. This centralized portal enables claims teams to rely on a central location for receiving forms, reminders, searching the knowledgebase and critical information about the status of claims decisions.
  For those customers wishing a standalone solution, the InHealth Decision™ is available as an ASP Offering with integration only to HCAI.
  
  
• Management Reporting
  InHealth captures an unparalleled level of detail relating to claims forms and decisions. This information is key to providing unmatched management reporting and insight into the performance of claims teams. 
  
  Visualization is consistent for every role, providing a direct line of site to the forms management chain. On the executive dashboard, data can be charted and filtered according to organizational hierarchy and time period.
  
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  Management reports, viewable online and in printed form, provide insight into all aspects of claims processing, including cost/utilization, IE usage, outcome analysis,
  and compliance.
  
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• Technology
  InHealth’s Claims Intelligence Solution has been developed using the latest Microsoft Technology for web site development.  It uses SQL Server 2005 as its data repository and ASP .Net 2.0 for the actual web pages.  The application is housed at a major hosting provider with full security control and backups.
  The software has been developed as an SOA application and is intended to run as an ASP (Software as a Service) application but could be configured to run in house if required. 
  
  
• Integration
  InHealth’s Claims Intelligence Solution has been specifically developed to easily integrate with third party applications. InHealth has developed a web services interface that allows for the easy transfer of necessary data between claims processing systems and InHealth.  InHealth has also included the necessary application components to provide a single-sign on capability with the insurance company’s in-house systems. InHealth also offers customers packaged integration to HCAI, so you can meet regulatory requirements without adding another integration to support and maintain.

For more information on Integration.

For an overview of the features and benefits of InHealth’s Claims Intelligence Software.