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APQC - Health Insurance Payor

APQC - Health Insurance Payor

Health insurance payors and providers are essential for providing service and protection to hospitals and patients alike. Whether insurance payors are subsidized through the government or are privately held, as is the case in several Western countries, systems are vital to ensuring that claims are processed correctly and in a timely manner. Medical organizations rely on the insurance payor to follow a claim process, beginning from the initial moment of service, all the way through to the final disbursement of coverage and/or medical expenses. For this to work effectively, health insurance payors must be trained within the necessary systems and processes to maintain regulatory compliance with regards to patient privacy and the medical organization’s expectation that coverage will be provided in a timely and prompt fashion.

However, the benefits of leveraging Mavim & APQC extend far beyond reducing cost or increasing efficiency:

  • By creating a common language to measure and evaluate every process in a business, Mavim provides an effective way to manage performance for such distinctly different processes such as initial claims that are created and submitted, employees who are responsible for cross checking the claims and processing them for payment, and compliance departments who must ensure that processes meet the privacy standards for each organization.

  • Identify the fits and gaps in current ways of working that lead to increased costs and longer lead times.
  • As much of a patient’s health care is now documented online, a systematic approach to both the front end and back end of the digital experience is necessary. The Mavim software can help identify best practices and where current process execution deviates from the norm, which in turn can ensure that the patient is experiencing the best care from start to finish, while the back-end processes are meeting the standards necessary for this expectation.

  • Global healthcare requirements differ around the world, but for many patients, healthcare comes at a cost. As healthcare moves to a more digital approach, it is essential that there is one way of working across each department to drive sustainable growth. Mavim provides a common language to understand differences in processes and make informed choices about which approach is the best, without impacting the level of care for the patient.

Demonstration video: APQC - Health Insurance Payor

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