Healthcare
providers are encountering problems in maintaining optimal service quality as
the global healthcare business continues to grow. The number of claims is
increasing as medical insurance coverage expands. Processing such claims, as
well as administrative work, patient care, and other everyday activities, is
time-consuming and expensive, requiring highly skilled employees. When a
healthcare provider processes claims in-house, there is a danger of delayed
payment, accounting errors, and client dissatisfaction. Furthermore, healthcare
providers must keep up with changes in rules as well as new services and
products that are introduced into the market for in-house claim processing.
Medical claims outsourcing ensures minimum error and faster turnaround,
lowering the risk of payment delays.
Previously,
claims were submitted on paper. Most claims are now made electronically, i.e.
electronic data interchange, thanks to the development of healthcare IT. The
introduction of an online medical claim process lowers paperwork for healthcare
professionals while also assisting in the payment of appropriate fees for
services rendered. Medical claims examiners or medical claims adjusters are
typically in charge of processing medical claims. However, in the case of a
high number of claims, medical directors analyse the claim and verify its
validity.
Medical Claims Processing Services
Industry Outlook is Positive in Developed Economies
The global
insurance penetration rate was a meagre 6.2 percent in 2014, with India having
insurance penetration rate on the lower side, at just 3.9 percent in the same
year. Furthermore, the survey discovered that India's insurance penetration
rate declined to 3.2 percent in 2015. Due to greater insurance coverage rates,
increasing number of claims, and expanding demand from healthcare providers,
the United States, Japan, the United Kingdom, Australia, Italy, and France are
some of the leading countries in the worldwide
medical claims processing services market. In addition, positive
healthcare policies and government initiatives like the Affordable Care Act
have increased demand for medical claim processing services in the United
States. Europe is increasingly becoming a significant market for medical claims
processing services. However, the implementation of Solvency II in Europe may
have a negative impact on European insurance companies.
Although the
medical claims processing services market in Asia Pacific and the Rest of the
World is still in its infancy, a large population base and rising insurance
awareness among the middle class are projected to drive demand for medical
claim processing services in the near future.
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