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Payers look to 3rd parties for claims processing, customer management

susan morse | healthcare finance news | 8 may 2017

PA's health technology expert, Jeff Sage, is quoted in an article in Healthcare Finance News. The article explains that healthcare payers are behind the times with technology updates to claims processing. This could be because updating these systems is likely to require capital expenditure of US$200-$300 million.

Commenting on this topic, Jeff Sage said: Claims processing is a system that touches every aspect of the organization, from the level of integration, workflows, staff training and reconciling data.

Jeff continues: The trend towards buying behavior is seeing technology as a service. Rather than the traditional own our own data center, there's a definite shift to get a service provider who can manage this for me, take care of the software and hardware maintenance, who can maintain, rather than maintain my own staff.

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Jeff goes on to say: The philosophy of insurers right now is, 'I really want to focus on the future (but) I have to deal with core technologies.' There's an interesting bit of tension. A lot of institutions want to invest on population health, enhancing the customer experience. There's a strong desire to focus there.

Jeff concludes: Even with the systems that are considered sophisticated, there's some that are good at Medicare Advantage, some that are good in the general marketplace and others that are focused on exchange-related activities. Payers are trying to enhance their technology.

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