A Philadelphia-based startup called TrueClaim thinks it has found a solution to combat insurance claim by bringing patients into the process, according to Fortune.
TrueClaim CEO Kasey Sousa said the process is no different than a credit card company calling a cardholder when it sees charges that looks suspicious.
In this case, it's a matter of using an analytics engine to look at claims and contact patients if something looks amiss. The TrueClaim engine knows which types of claims tend to go together, as well as how long certain procedures should take and therefore cost, according to the article. If a patient's answers to a series of yes-or-no questions don't match what's on the bill, TrueClaim tells the insurer to rectify the bill with the doctor.
A 2014 beta test saved each patient who was contacted $60. This resulted in $140 in savings per transaction for insurers, the article said. Most of the issues spotted were honest mistakes such as coding errors, Sousa said, referring to the complexity of ICD-10 claims processing.
As a result of the beta test, Independence Blue Cross is discussing the use of TrueClaim in a pilot program with its 250,000 members. In particular, the pilot would focus on making sure customers with high-deductible health plans are charged appropriately. This matters, particularly since studies show that high deductibles cause Americans to delay medical care, which leads to even higher healthcare costs for emergency services.
In addition to the pilot, TrueClaim is working with partners to produce a data set of approximately 40 million claims and further augment its database. It seems the payer industry can use the help--insurance industry executives don't think analytics technology is evolving fast enough to meet their needs, FierceHealthPayer previously reported.
- here's the Fortune story
Health IT can't evolve to handle toughest insurance industry challenges, execs say
High deductibles cause Americans to delay medical care
Somebody, please, fix the broken healthcare payment system
Major insurers ready for ICD-10 claims processing