SparkActions
Claims Statusing
Automate and Streamline Your Approach
Eliminate unnecessary manual intervention with SparkActions Claim Statusing. Save time and ensure timely reimbursements with streamlined workflows and intelligent status updates, empowering your teams to focus on what matters most.
The Challenge
Manual Claim Follow-up
Until recently, healthcare organizations only had one way to monitor the status of their claims—manually. That manual process has been done diligently by dedicated teams that watch the claim status and ensure that it is adjudicated in a timely manner. This manual effort can take multiple attempts, resulting in hundreds of FTE hours each month.
The Solution
Claim Statusing Automation
SparkChange has created a unique extraction process that helps us identify the claims that have been sent to the payers. We then determine which claims require status updates without requiring any manual intervention from your team. We use API capabilities to access payer portals like Availity to check the status of your claims. This process reduces the need for your team to intervene. We then provide detailed updates on the payer status to the account timeline.
Status Updates
In Process
Claim Denied
Claim Paid
Workflow Queue Automation
We can layer in additional FTE savings by driving queue workflows based on payer responses to further eliminate manual user intervention.
Example 1
For claims with “In-Process” status, we set a follow-up date and continue to monitor until it’s resolved or exceeds the threshold. Once done, the follow-up date is released for manual follow-up.
Example 2
We set a follow-up date of 10 days for “Claim Paid” or “Claim Denied” status claims, to allow time for the remit to post. If it posts as expected, the follow-up queue resolves automatically. If not, it will be reviewed by the user in 10 days.
Example 3
If a claim is not adjudicated after the third attempt, we’ll release the follow-up date to push it back to the user queue for manual follow-up.
The Timeline
We will follow a timeline, generally outlined by the client, for payer thresholds of when claims should be statused based on payer expectations.
First Attempt
10 days post “transmission” for reconciliation purposes.
Second Attempt
30 days post transmission. If not yet adjudicated, it’s posted to the system.
Third Attempt
50 days post transmission. If not yet adjudicated, it’s posted to the system.
No Claim on File Reconciliation
We check the claim status 10 days after sending it to ensure the payer got it and processed it. This is helpful because we sometimes find that while the payer accepts the claim, they can’t process it. This usually happens because of demographic mistakes, such as incorrect insurance registration ID numbers. These mistakes are only found later in the process and can cause delays and problems. Suppose we receive a “No Claim on File” status after the payer has accepted the claim. In that case, we’ll queue it up to be fixed in order to avoid delays.
Why Choose SparkActions Automations?
SparkActions Automations are driven by data to optimize your healthcare revenue cycle. We take a proactive approach, utilizing comprehensive insights to identify automation opportunities tailored to your needs. In the complex healthcare landscape, our solutions alleviate burden and increase capacity, ensuring smoother operations and improved outcomes.