claims processing SERVICES

Strengthen and grow your customer base with full-suite claims processing services.

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Streamlining Claims and Maximizing Efficiency with accurate insurance claims processing

Claims processing is a process undergone by insurance companies to determine whether it will pay for a claim. This process involves document processing, reviewing, investigating the circumstances, and determining whether the policy covers the loss or damage of the claim. If the claim is approved, the insurer will typically pay the policyholder according to the terms of the policy.

Many businesses have found that outsourcing non-core processes can improve efficiency. Insurance claims processing is one such process that has become significantly outsourced by insurance providers.

The claims processing process is responsible for resolving outstanding payments in various industries, including healthcare, insurance, finance, and accounting. Generally, each company has a separate claims division dedicated to managing workflow for each claim once a formal request is submitted.

Outsourcing claims processing services allows you to focus on your core competencies while utilizing ready-made solutions from professional providers. It can accelerate growth by improving sales performance and mitigating financial risks.

Claims processing services

We provide accurate and cost-effective industry-optimized claims processing services to streamline your business processes. Our insurance document processing platform and experienced staff ensure high-quality and accurate data. Here’s a brief overview of our professional services:

Claims data entry service

Outsourcing claims data entry can boost productivity and accuracy. We create a customized service for capturing information and completing fields for validation, provider lists, and medical codes. Our data entry agents can validate commission statements with the highest accuracy rate.

The layout of the output file is clearly defined, and data entry begins once claim forms are received. Our expert team is experienced in processing various claim types.

Invoices and bills

Medical records

Incident reports

Contract, Policy, and Legal documents

Bank statements and payment records

Insurance declarations

Medical claims processing service

We offer a comprehensive service package to check, approve, and pay for the medical services that clients receive from healthcare providers.

Our medical claims processing service helps insurance companies manage their costs and ensure that customers get the benefits they are entitled to.

Explanation of Benefits (EOB)

Assignment of Benefits (AOB)

Coordination of Benefits (COB)

Claim submission records

Authorization and referral forms

Claim submission records

Medical coding manuals (ICD-10, CPT)

Insurance claims processing service

If your insurance firm is receiving many claim requests and other documents, we can quickly and accurately organize the data from different sources.

We utilize intelligent automation technologies to perform various tasks such as data entry, application processing, insurance claims examination, and clearing backlogs with OCR to reduce processing time.

Claim form and Claim history

Medical records

Incident reports

Contract, Policy, and Legal documents

Bank statements and Payment records

Income documentation

Hospital discharge document processing

Our services support the hospital procedure that involves preparing, sending, and receiving the documents that contain information about a patient’s hospital stay and follow-up care.

DIGI-TEXX ensures that all patients and healthcare providers have a precise record of the patient’s condition, treatment, and needs after leaving the hospital.

Doctor diagnosis

Discharge summary

Medication list

Diagnosis code and Diagnosis description

Follow-up appointment schedule

Discharge plan

Instructions for self-care

You’re gonna love dIGI-TEXX

Managers from many kinds of businesses turn to DIGI-TEXX to optimize their administrative costs.

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Our Deployment Models

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How does our claims processing methodology work?

Partnering with our insurance BPO company that has a digital mindset can help you transition claims processing to a more nimble, technologically-driven environment. Here are the optimized steps:

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Frequently Asked Questions

Our team of experts is here to answer any questions you may have and provide you with a free consultation. If you don’t see an answer for you below, feel free to send us a message.

Claims processing outsourcing is a process that allows insurance companies or businesses to outsource the handling and verification of their insurance claims.

This method was first introduced by the International Association of Insurance Supervisors (IAIS) as a way to ease the burden on companies with high volumes of claims due to limited human and technological resources.

Companies can offload some of their workloads onto an outsourced provider, allowing them to manage their workloads more effectively.

Outsourcing claims processing services gives businesses many advantages. Aside from making the process more efficient, it also positively affects the efficiency of the business’s other in-house services:

  • Reduce Costs: Insurance claims need a lot of time and resources to be fully processed. Our company already has insurance claim teams at their disposal. With our assistance, you can avoid hiring additional in-house staff to finish the task.
  • Improves customer experience: As a client-facing business, you have a lot to handle. Customers expect prompt and top-notch services, along with attentive and empathetic support. Fortunately, claims processing outsourcing teams can provide that human touch and enhance the quality of your customer services.
  • High success rate: We combine human expertise with technologies such as RPA in insurance claims processing. Our robotic process automation can standardize processes with 99% accuracy. We also integrate industry-leading technologies without requiring changes to your current technology stack.
  • Improve Business Planning: You can make intelligent data-backed business decisions through insightful business reports.
  • Better Cash Management: We help you streamline bank account management and forecasting to ensure you have the cash flow to achieve your goals.

Insurance claims processing tasks that can be outsourced include, but are not limited to:

  • Reviewing claim submissions
  • Obtaining and verifying information
  • Corresponding with insurance agents and beneficiaries
  • Preparing claim forms
  • Managing and maintaining records of insurance policies and claims in database systems
  • Determining policy coverage and claim payout amounts.

These tasks are generally repetitive and compliance-based, requiring a high level of attention to detail, which makes them well-suited for outsourcing.

ICD-10 and CPT are two crucial coding systems used in the field of healthcare to describe medical diagnoses, procedures, and services. They serve different purposes and are utilized for distinct aspects of healthcare documentation and billing:

  1. ICD-10 (International Classification of Diseases, 10th Revision):
    • Purpose: ICD-10 is primarily used to code and classify diseases, conditions, and other health-related issues. It provides a standardized way to document and track a wide range of medical diagnoses.
    • Components: ICD-10 codes consist of alphanumeric characters and can be quite detailed. These codes describe a patient’s diagnosis, injury, illness, or medical condition. They can also indicate the cause of the symptoms and their severity.
    • Usage: ICD-10 codes are crucial for medical billing, insurance claims processing, healthcare statistics, and clinical research. They help healthcare providers communicate patient diagnoses accurately and facilitate the reimbursement process by insurance companies.
    • Example: An ICD-10 code might be used to specify a diagnosis like “Type 2 diabetes mellitus” or “Fracture of the distal radius.”
  2. CPT (Current Procedural Terminology):
    • Purpose: CPT codes describe medical procedures, services, and treatments by healthcare professionals. They encompass a wide range of medical activities, from office visits and surgeries to diagnostic tests and therapeutic interventions.
    • Components: CPT codes are five-digit numeric codes, with some codes having modifiers to provide additional details or specify procedure variations.
    • Usage: CPT codes are essential for medical billing and reimbursement. Healthcare providers use them to report the specific services they’ve performed during patient encounters. Insurance companies use these codes to determine payment amounts for those services.
    • Example: A CPT code might be used to describe a procedure such as “Endoscopy of the colon.”

Your Industry will benefit the most from our services

DIGI-TEXX implements automation claims processing tools and models to provide solutions for various industries. By combining technology with human analysts, we can efficiently analyze large amounts of data, resulting in cost savings and improved performance. There are several use cases across many industries:

healthcare

DIGI-TEXX helps healthcare providers receive reimbursement more quickly for their services, reducing the administrative burden on healthcare providers and freeing up staff to focus on patient care.

INSURANCE

We streamline the claims handling process, reducing the time and costs associated with maintaining an in-house claims processing department of insurance institutions.

BANKING

Our professional claim processing services employ experienced specialists to help process claims faster with a high accuracy rate, supporting to detect and prevent fraudulent claims. This can help reduce losses due to fraudulent claims and protect the bank’s reputation.

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What makes us an ideal claims processing service provider for you?

Our company offers claims processing services to clients worldwide, delivering high-quality results. Outsourcing your claims needs to us provides a range of benefits, including:

Flexible pricing model

We offer flexible pricing models based on the hour/transaction/volume and dedicated resources/packages. Clients can select the right model which best fits their purpose.

Round-the-clock support

Our operation is 24/7/365 since the client’s business continuity is always our top priority.

Data security

Confidential information will remain secured and be restricted from outside exposure with a reliable information security management system (ISMS) based on the ISO 27001 standard with GDPR compliance.

Data accuracy

At DIGI-TEXX, we understand that data accuracy is the first and critical component of the data quality framework. We combine AI technologies and our specialists to ensure the highest accuracy rate.

Cost optimization

Outsourcing transforms fixed costs into variable costs and allows our clients to prevent large expenditures for business in the early stages and long term.

Scalability and flexibility

Our service can adapt quickly to fluctuating volumes without compromising productivity and processing quality.

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Our exemplary project delivery capacity

Our claims processing solutions add value to any business (from small to large enterprises) around the world.

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