The focus of healthcare, globally, has been on treatment of disease and taking care of the sick. The approach has been reactive i.e. treat the sick. This approach basically leads to intervention only when the health of any person reaches a critical stage, with clinical intervention and hospitalization being the outcome. On top of this the healthcare system is constrained by spiraling cost driven by inefficient care system. This unsustainable economic impact of cost of care is driving the focus towards proactive health and care management.
Processing claims quickly and accurately is one of the biggest challenges payers face today in healthcare industry. Huge volume of claims notwithstanding, multiple and incompatible systems requiring significant manual hand offs have made the timely disposal of claims the single biggest burden on operating costs of payers. Add to it the problem of incorrectly filed claims that payers need to handle, leading to choking of band-width on account of re-processing; the problem suddenly becomes even more acute. With state specific regulations penalizing such delays, it has become a matter of survival for payers to figure out the optimal trade-off between analysis one claim warrants versus time it takes to get it through the system.