{"id":4333,"date":"2023-07-20T11:32:39","date_gmt":"2023-07-20T11:32:39","guid":{"rendered":"https:\/\/insights.scalablehealth.com\/?p=4333"},"modified":"2025-07-07T14:57:51","modified_gmt":"2025-07-07T14:57:51","slug":"claims-analytics-turning-lemons-into-lemonade","status":"publish","type":"post","link":"http:\/\/13.90.168.50\/shblogs\/2023\/07\/20\/claims-analytics-turning-lemons-into-lemonade\/","title":{"rendered":"Claims Analytics: turning lemons into lemonade"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Reading Time: <\/span> <span class=\"rt-time\"> 2<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><style>\r\n#site-navigation {\r\n        background-image: none !important;\r\n    height: 0px !important;\r\n    padding: 0 !important;\r\n}\r\n\r\n.site-title {\r\n    display: none;\r\n}\r\n\r\n.site-description {\r\n    display: none;\r\n}\r\n<\/style>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">In healthcare insurance, the claim is central to almost all parties involved in patient care. It contains every detail of a patient\u2019s care \u2013 the diagnosis, status codes, procedure codes, condition codes, and much more. 80% of all premiums are spent on claims\u2019 payment and associated handling charges. Therefore, efficient claims operations\/management within the healthcare industry significantly impact profitability, solvency, and competitiveness.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">With so many claims to handle, payers don\u2019t have time to sift through all of that data to evaluate every claim and run the risk of missing valuable pieces of information in their decision making.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">By leveraging a real-time claim analytics solution integrated with performance measurement scorecards and predictive analytics tools, a payer can derive insights from their data to make claim decisions faster. This level of depth, coupled with the precision of insights on the claim processing cycle, also supports the payer organization to analyze millions of claims per day, leading to faster revenue generation.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Millions of data can be mined based on several parameters, such as the type of provider, procedure codes, and member eligibility. Claims need to be analyzed to understand the procedure codes, billed amount, and other essential attributes to identify overpayment risks.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">The Payer needs to implement processing functionalities that incorporate a member\u2019s criterion of benefits details and the provider\u2019s contracted rates, allowing accurate processing of the submitted claims in a matter of seconds.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Further advantages include the reduction of claim handling costs, quicker payment times, and accurate claim assessments. Claims units that leverage their data archives will not only be able to control costs better and reduce cycle times but will also be able to advance the business objectives of the organizations. Such payer companies will make quantum leaps in operational efficiency, financial stability, and cost leadership.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Payer companies of the future need to create \u201cPerformance-Focused\u201d claims functions. For example, ACOs in the United States use analytics to determine the services to include in a retrospective or prospective bundled payment arrangement or the data needed, at the most granular level, to select the high volume, high-cost benefit utilization. These detailed analyses provide healthcare payers with \u2018at-the-point information\u2019 required to automate business decisions and adhere to the ever-changing market demands in a timely, cost-efficient manner.<\/p>\r\n\r\n\r\n\r\n<div class=\"getin-touch\">\r\n<div class=\"container\">\r\n<div class=\"row\">\r\n<div class=\"col-10 mx-auto\">\r\n<div class=\"get-box\">\r\n<h1>Want Better Data, Smarter AI, and Faster Decisions? Talk to us today!<\/h1>\r\n<a href=\"http:\/\/123.63.97.202:81\/scalable-systems\/contact.aspx\" target=\"_blank\" rel=\"noopener\">Get in Touch<\/a><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Reading Time: <\/span> <span class=\"rt-time\"> 2<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span>In healthcare insurance, the claim is central to almost all parties involved in patient care. It contains every detail of a patient\u2019s care \u2013 the<\/p>\n","protected":false},"author":1,"featured_media":4690,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-4333","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blogs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Claims Analytics: turning lemons into lemonade - Scalable Health Blogs<\/title>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"http:\/\/13.90.168.50\/shblogs\/2023\/07\/20\/claims-analytics-turning-lemons-into-lemonade\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Claims Analytics: turning lemons into lemonade - Scalable Health Blogs\" \/>\r\n<meta property=\"og:description\" content=\"Reading Time:  2 minutesIn healthcare insurance, the claim is central to almost all parties involved in patient care. It contains every detail of a patient\u2019s care \u2013 the\" \/>\r\n<meta property=\"og:url\" content=\"http:\/\/13.90.168.50\/shblogs\/2023\/07\/20\/claims-analytics-turning-lemons-into-lemonade\/\" \/>\r\n<meta property=\"og:site_name\" content=\"Scalable Health Blogs\" \/>\r\n<meta property=\"article:published_time\" content=\"2023-07-20T11:32:39+00:00\" \/>\r\n<meta property=\"article:modified_time\" content=\"2025-07-07T14:57:51+00:00\" \/>\r\n<meta property=\"og:image\" content=\"http:\/\/13.90.168.50\/shblogs\/wp-content\/uploads\/2023\/07\/Claims-Analytics-turning-lemons-into-lemonade-1.jpg\" \/>\r\n\t<meta property=\"og:image:width\" content=\"2048\" \/>\r\n\t<meta property=\"og:image:height\" content=\"2144\" \/>\r\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\r\n<meta name=\"author\" content=\"Scalable Health\" \/>\r\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\r\n<meta name=\"twitter:creator\" content=\"@ScalableHealth\" \/>\r\n<meta name=\"twitter:site\" content=\"@ScalableHealth\" \/>\r\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Scalable Health\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\r\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/#article\",\"isPartOf\":{\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/\"},\"author\":{\"name\":\"Scalable Health\",\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/#\\\/schema\\\/person\\\/00766d6f66f6a7526f68f673d9e82ecf\"},\"headline\":\"Claims Analytics: turning lemons into lemonade\",\"datePublished\":\"2023-07-20T11:32:39+00:00\",\"dateModified\":\"2025-07-07T14:57:51+00:00\",\"mainEntityOfPage\":{\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/\"},\"wordCount\":396,\"commentCount\":0,\"publisher\":{\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/#organization\"},\"image\":{\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/wp-content\\\/uploads\\\/2023\\\/07\\\/Claims-Analytics-turning-lemons-into-lemonade-1.jpg\",\"articleSection\":[\"Blogs\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/\",\"url\":\"http:\\\/\\\/13.90.168.50\\\/shblogs\\\/2023\\\/07\\\/20\\\/claims-analytics-turning-lemons-into-lemonade\\\/\",\"name\":\"Claims Analytics: turning lemons into lemonade - 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