Health plan operators deal daily with a huge flow of documents that relate to the institution's economy, such as invoices, medical records, contracts between service providers and/or accredited networks, financial reports, etc.

In a rigid and competitive sector, such as the healthcare sector, maintaining the operator's financial health is essential to survive in the market and achieve the institution's objectives. Therefore, for the health plan manager, it is always a challenge efficiently handle all this data.

Want to know how a more transparent medical bills program can help your organization? In this article, we will understand the importance of this and give tips on how to apply to the health plan provider. Check out!

How important is a more transparent medical billing program?

Transparency, for the health plan operator, is synonymous with efficiency. Having a more transparent medical billing program is essential to achieving excellence at the institution. Among its benefits, we can mention:

• faster processes and more effective service, both for the beneficiary (or for accredited networks) and for service providers;
• cost reduction, reduction of the accident rate and the occurrence of medical glosses;
• better basis when drawing up strategic planning, offering a broader vision for the manager.

How to make the medical bills program more transparent?

Clarify the terms of the contract

When the accredited institution or the beneficiary signs a contract with the health plan operator, this contract establishes which services the providing institution can provide.

Thus, when the beneficiary or institution requests a procedure, such as a consultation, an exam or treatment, the Medical Accounts department processes this request, making it compatible with the contracted tables.

This way, to achieve a medical bills program more transparent and avoid cheats, it is important that the operator is clear and guides all parties about the services that the contract encompasses. This helps to avoid hospital disallowances, which harm the institution's revenue, and avoids a negative balance the following month.

Maintain good communication with service providers

It is common in operators' routine for accredited networks to question adjustments and contractual clauses, request a more detailed analysis of procedures or even request refunds.

Therefore, in addition to offering clear information to agents, it is also important to keep the communication channel always open, responding to everyone promptly and clearly. At the end of the month, this efficient exchange of information positively impacts the institution's revenue.

Try specialized software

Technology is increasingly present in the daily lives of healthcare institutions, whether through new techniques, which enable faster and more efficient results, or by assisting the institutions' administrative processes.

Therefore, adopting software capable of handling data in an automated way is a great solution to obtain more transparent results. Below, check out how specialized software can help health plan operators achieve excellence!

How can software help achieve the goal?

Optimizing processes and reducing rework

As we said, when the beneficiary and/or the institution activates the health plan to carry out a procedure, it is up to the operator to analyze whether the justification for this procedure is valid.

Traditionally, this verification is done manually, through the analysis of a series of documents, which, in turn, are subject to losses, fraud and unnecessary bureaucracy.

Therefore, using software in this type of procedure speeds up information, allowing artificial intelligence to carry out the first analysis of requests and “filter” what really matters, leaving the administration to analyze only the cases that deserve to be analyzed.

Monitoring the progress of processes

Specialized software can also help with monitoring the institution's resources. As we said, it is common in the operator's routine to deal with questions about adjustments, contractual clauses, etc.

Software can help control the progress of these processes, reducing the chance of the institution making mistakes, delaying deadlines and suffering legal penalties, which end up costing money.

Evaluating service providers

Health plan operators work together with several other institutions, which, in turn, offer different types of services. Software specialized in operator management helps to have a macro view of providers, allowing the manager to search for information in an efficient and automated way in the program itself — instead of searching for documents in drawers or folders on the computer.

Furthermore, artificial intelligence software usually offers a prior analysis of the provider's performance, indicating weaknesses and strengths and assisting in the decision-making process.

Providing an efficient way to query data later

Artificial intelligence software usually stores information in the cloud, that is, on the internet. In addition to offering more security for information, this system is also beneficial when consulting previous data, such as the history of contracts or services performed by a specific beneficiary.

Furthermore, information automation also eliminates redundant or unnecessary data, optimizing the operator's resources. This systematic way of dealing with data helps the institution to have more basis when analyzing medical bills.

How do you know which system is ideal for the operator?

When choosing software, it is important to choose a system that is specialized in health plan operators. Furthermore, according to the operator's needs, the manager may ask:

• Is the investment worth it? How long will it take for the operator to have results?
• Is the system simple? Does it offer an intuitive interface?
• Is implementation fast?
• Can the software be integrated with other systems?
• Is the software more “rigid” or is there the possibility of automation?
• Does the system offer remote support?
• Does the system offer transparent data?

Therefore, we saw that a transparent medical billing system is essential for the operator's financial health, allowing it to work more efficiently and ensuring cost reduction. We also saw how software specialized in health plan operators is advantageous for the institution!

And there? Did you like our content about medical bills program? Want to know how we can help you in practice? Then, contact us! SAUDI is a company specialized in automating the medical bill audit process. We are the only one on the market focused on costs! We will be happy to help you!