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Claims processing and data analysis

Milliman Health ClaimsRef

Reduce errors and improve cost savings with standardized, consistent claims processing tools.

The challenge

Inconsistent claims processing increases cost and risk

Claims processors face time limits on claim settlement, making it challenging to perform detailed analysis. Rapidly evolving medical practices and non-standardized claim codes further complicate their work. Without tested and proven data structures and a unified team approach, excessive and unwarranted billing practices go unchecked.

The solution

Manage health claims efficiently and accurately with clinical experience-based tools

Milliman Health ClaimsRef provides comprehensive, regionally appropriate reference guidelines to review billed services on health claims. It also offers business rules that can easily be integrated with claim systems to automate reviews.

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Serving each stakeholder

How Health ClaimsRef serves your needs

For insurers and third-party administrators (TPAs)

Process claims efficiently and save money

Use a standard system of checks to avoid errors and omissions. Quickly identify unwarranted or excessive services.

For reinsurers

Build client capacity

Add value for clients with your reinsurance support. Enable efficient and consistent practices for your clients.

For system integrators

Optimize rules-based automation

Simplify and streamline digital practices in your region to support benchmarking and future analysis for clients. Our rules also help ease the integration process and avoid delays.

Benefits

Milliman Health ClaimsRef benefits

Increase efficiency

Preauthorize claims with automated checks and reduce unwarranted use of expensive clinical resources. Settle clean claims quickly without time-consuming negotiations.

Improve quality of processes and personnel

Promote standardization and uniformity in your business practice with tools that are easy to implement. Support training of claims team members with built-in tools.

Discover and correct errors and omissions early

Flag potentially incomplete, excessive, or fraudulent claims for manual intervention by applying our guidelines and rules upon receipt of claims.

FEATURES

Milliman Health ClaimsRef features

Web-based portal

Access hundreds of guidelines for common and high cost inpatient medical and surgical conditions from any device, wherever needed.

Practical and pragmatic rules

Use rules based on in-depth clinical experience, specific to your region, and designed especially for the claims adjudication process. The solution is supported by published research and market validation.

Supported, customizable approach

Rely on the experience of a clinical team of doctors and actuaries with global experience and awareness of regional practices and codes. Adapt and configure rules to specific insurance products and local coding systems.

Consistent maintenance

Expect seamlessly integrated updates and enhancements from Milliman to keep current with trends in your region.

INSIGHT

Related insight

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