{"id":22082,"date":"2024-06-19T14:36:47","date_gmt":"2024-06-19T14:36:47","guid":{"rendered":"https:\/\/www.varshabi.com\/HCIM2\/?p=22082"},"modified":"2024-07-11T15:54:33","modified_gmt":"2024-07-11T15:54:33","slug":"understanding-auto-adjudication","status":"publish","type":"post","link":"https:\/\/www.varshabi.com\/HCIM2\/understanding-auto-adjudication\/","title":{"rendered":"Understanding Auto Adjudication"},"content":{"rendered":"\t\t
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Auto adjudication is the process of swiftly processing insurance and public benefit claims, without the need for manual intervention or decision-making for each claim.\u00a0 In essence, it\u2019s about harnessing the potential of technology and smart system configuration to handle claims automatically.<\/p>

It\u2019s often misconstrued as a straightforward process.\u00a0 Configure certain rules and parameters, set up your system, claims are paid in full, pay a partial amount, or deny the claim all together. Voil\u00e0! You\u2019re done!\u00a0 In reality, it\u2019s a nuanced and complex endeavor. The industry standard benchmark for auto adjudication hovers around 80% and while organizations may aim for that auto adjudication rate, many fall short, with first pass rates ranging from 10% to 70%.<\/p>

Achieving a high auto adjudication rate is often seen as a sign of a well-optimized claims department but it\u2019s not the whole story.\u00a0 Here\u2019s the twist: auto adjudication isn\u2019t just about numbers.\u00a0 It\u2019s about efficiency, accuracy, and ensuring that your claims department is working smarter, not harder.\u00a0 The real question to ask is: \u201cWhere are my examiners spending their time?\u201d\u00a0 Identifying those specific scenarios and workflows that genuinely require human decision-making and striking the right balance between timeliness and precision is key. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The Role of System Configuration<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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System configuration plays a pivotal role in the auto adjudication process, potentially boosting rates by 15-25%.\u00a0 But there\u2019s an art to it.\u00a0 A well-defined set of rules is the backbone of efficient auto adjudication but too much automation can lead to an excess of pended claims, defeating the purpose.\u00a0 System configuration must be optimized to ensure that claims requiring manual processing are the exception, not the rule.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Potential Boost<\/div> <\/div>\n <\/div>\n <\/div>\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Introducing SymKey: Beyond Auto Adjudication<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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SymKey isn\u2019t just auto adjudication. It\u2019s a game-changing solution that not only complements system capabilities, but it can also help address system functionality challenges. SymKey goes beyond system auto adjudication by mimicking the work of a claims examiner. Unlike traditional auto adjudication, which relies on system rules, SymKey\u2019s approach is backed by real-world claims operations expertise.\u00a0 Those complex scenarios that usually require the touch of an experienced claims examiner\u2026 SymKey can handle them painlessly.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Edit Any
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SymKey can touch and edit virtually any claim header or detail line field<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Automate Manual Tasks<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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SymKey can touch and edit virtually any claim header or detail line field<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Improve Accuracy<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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SymKey automates the process of applying all note types<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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The SymKey Advantage<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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