Claims Processing Speed Matters — Here’s Why

claims processing speed

TPAs Are Healthcare Superheroes

Why? Because a lot of people are relying on you. It might not be immediately apparent, either. It takes some thought into who is impacted by what you do. Take plan participants, for example. Whether it’s the employee of the company you’re working with or their spouse, they’re both expecting you to perform your function quickly. Even if they don’t know you’re a TPA, as many solutions are white-labeled, you’re the one doing the work behind the scenes. If you don’t follow through, that participant and his or her family could be impacted financially.

Your superpower isn’t limited to participants, alone. Employers are relying on you to work quickly for a number of reasons. Efficient claims processing speed is important as it ensures employees are satisfied with the results, thereby saving HR departments from having to field and look into employee concerns and questions. It also reveals important data about how plan participants utilized their benefits over the plan year, allowing employers to explore new benefit offerings that could yield additional revenue for brokers and (in turn) you.

And of course, claims processing speed is essentially a key performance indicator that your broker partners will be paying attention to. They’re the ones bringing you to the table for new opportunities, and so they will want to ensure you’re able to meet — and ideally exceed — prospects’ expectations. By upholding your end of the promise to prospects, you’ll be making the broker a superhero as well, which translates into future opportunities for your business.

Automation Speeds Up the Workflow for These Groups

We’ve already shared a great deal about the value of an automated customer experience, but what are the implications for workflow? Remember, the goal of automation is not only to maintain positive relationships with your clients and partners but also to make your life easier as a TPA. Automation saves your team from getting bogged down in the countless administrative tasks associated with EOB processing.

Automation also inherently helps you redefine and streamline the way you do business. A significant amount of TPA’s workload involves tasks that are simply moving things from A to B to achieve C. This includes retrieving and attaching PDFs to emails, loading files into various software platforms, sending notifications or alerts, and compiling data for reports. While the work doesn’t sound hard, it’s certainly time-consuming and manual. And when you multiply this workload by the number of claims processors you have, it’s also exceptionally expensive.

This is one of the most significant benefits of automation on your claims processing speed — it can help you significantly reduce the costs associated with your primary offering. By freeing up resources, your TPA will be able to pursue new opportunities, such as enhancing technology in other areas of your business, allocating funding for other strategic objectives, and further refining other internal processes. This can all be achieved without having to hire additional team members because automation takes care of it for you.

Never, Ever Automate a Bad Process

It’s important to understand that while automation can make your workflow more efficient, a bad process is still a bad process — even if you automate it. Turning a lengthy, manual workflow that isn’t properly streamlined or tends to cause other issues into an automated version doesn’t make it better. In fact, it can make it worse. That’s because a bad workflow that’s given the freedom to run faster will continue to produce bad results and problems faster. 

For example, say that your company requires a supervisor- or manager-level review of certain claims. If you automate the way in which those claims come in, you’ll be processing more of them faster. The supervisor or manager on the reviewing end will be getting bogged down with reviews faster, too. As the reviews pile up, the pressure mounts on that individual and participants’ claims will start going unanswered and unsubstantiated for longer. And your customer service teams will start hearing from them soon. Clearly, automation didn’t help streamline the workflow in this situation — it only made things worse.

If you’re considering an automated solution to support faster claims processing speed, also consider evaluating and auditing your various workflows. Review who’s doing what, how they’re doing it, the amount of time it takes, where information goes, how it gets there, and of course, how it can all be done more efficiently. Once you’ve reviewed and optimized those workflows, any automation you inject into your environment will make those workflows even stronger rather than keeping them problematic.

Enhance Your Workflow and Claims Processing Speed with TPA Stream

As a leading healthcare integration platform, TPA Stream bridges the gap between TPAs’ existing workflows and what they need to make them even better. With multiple benefits administration platform integrations and numerous carriers to choose from, we’ve successfully helped TPAs and other organizations across the country enhance their operations for long-term success.

Learn how we can do the same for you.



Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better healthcare outcomes for employers and their employees.

Learn more about TPA Stream here.

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