Health Insurance Insights
According to the Centers for Medicare and Medicaid, spending for health services will grow by close to 6 percent per year through 2019. The payers in this process are always trying to reduce the amount of the money spent, but at the same time to ensure that the necessary medical therapies and appropriate levels of care are delivered to the patients. As the coverage of the plans is extended and new procedures and treatments are included, the amount of information which needs to be processed and validated increases. This makes impossible the manual processing of generated medical claims and the management and resolution of inconsistencies. What is required is a new, automatic approach to match billable activities with the medical necessities and recommendations by regulators.
Health Insurance Insights streamlines the process for defining medical consistency rules. The system automatically discovers expert validated medical information in highly trusted data sources approved by the medical regulation authorities.
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