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Timely and efficient payment of claims is a necessity for all stakeholders in today’s high-pressure healthcare environment. All too often that goal is made harder to achieve by outdated processes, the complex diversity of claims, and the demands of government regulation.

Obstacles to claims processing effectiveness

  • The many different formats of claims submitted by providers.
  • Errors and inefficiency cause delays. Resulting failure to process claims within the permitted time-frames can lead to financial penalties for late payment, and dissatisfied customers.
  • The huge variety of contract conditions and fee schedules that apply across diverse payers and providers.
  • Payers face a growing and increasingly demanding customer base, making manual data entry even more inefficient.  
  • The exacting provisions of ‘Obamacare’ in the US impose new documentation requirements.
  • Manual claims processing is slow and error-prone.
  • Delays due to errors result in late payments and dissatisfied customers.

How NDS helps optimize claims processing?

We convert your paper-based claims to a universally accepted EDI format, capturing and verifying all the data needed for automatic adjudication. These data records are then used by your auto-adjudication systems to speed claims processing.

NDS breaks this task down into several stages, enabled by our unique Technovation™  platform:

  • You provide NDS with your paper claims, which are then batched and scanned.
  • The data from those claims is captured by our skilled associates. Sophisticated claim data validation tools are used to reduce or eliminate the need for manual adjudication.
  • The claims information is authenticated using our double review procedure which verifies the presence of all data required for adjudication. If data is missing, our software generates an exception report.
  • The completed records are output for download in an EDI form useable by your existing pre-adjudication and auto-adjudication systems.

In fact, NDS’ solution even allows integration of your provider and eligibility databases into the data capture process itself, for improved adjudication results.

How do claims payers benefit?

NDS’ Healthcare Claims Processing service allows you to operate with greater efficiency and accuracy, while costing substantially less than traditional methods. Here’s what NDS can deliver:

  • Higher data accuracy, leading to improved auto-adjudication rates.
  • Faster turnaround time.
  • No change to your existing processes.
  • Elimination of error-prone manual data entry and adjudication processes through business automation.
  • HIPAA-level information security.
  • Adjudication within the 72-hour contractual window.
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