Barriers to automating claims review
Fortunately, just as claims challenges have grown, so too have the solutions. For one, many payers have embraced automated tools as a means of spotting claims errors without adding to their internal administrative burden. However, current automation programs don’t go nearly far enough — and that’s if payers can incorporate them into their claims review infrastructure.
Many payers find these programs too cumbersome or expensive to adopt. A July 2022 Optum survey of health plan executives found that for 63% of respondents, the main barrier stopping them from pursuing an automated claims review service was a lack of resources. Another 55% felt that migrating their associated providers from their current system to a new automation tool would be too difficult.3
Even when payers want to pursue claims review automation, they’re not always able to do so. In fact, 50% of the same survey’s respondents found the prospect of automated claims reviews intriguing and had even outlined a strategy for pursuing it but had yet to take the leap. Perhaps that’s why roughly 31% of payers still have entirely manual claims review processes.4 And while automation isn’t the silver bullet many payers may imagine it to be, an entirely manual approach simply isn’t tenable long-term.