ClaimFetch

The Challenge of Searching for Claims

"Get a sample of the claims we need to understand a problem? At least a week." -- Claims Supervisor The healthcare claims process is driven by volume. Even small payers are finalizing thousands of claims a week. Most carry at least a week of claims in backlog. Finding the claims you need in those huge 'piles' can be a challenge. ClaimFetch is tool designed to make that task easier for staff across a payer organization to perform. Provider reps should be able to pull claims with a particular denial reason -- and forward them if necessary. Claims staff should be able to quickly find claims with a particular modifier or procedure code to check benefit or provider contract configuration. It should be easy to pull the claims you need to tackle a particular claims process question or issue.

ClaimFetch: Designed to Search Claims

ClaimFetch is a turnkey claim search tool. Why do you need to search for claims? Because lots of claims process issues, at the bottom, require a sample set of claims to understand or identify the root cause. ClaimFetch was designed to support the needs of claims, provider relations, and configuration departments -- where staff often need to pull samples of claims to support operational analysis.

• Find and Fix More Claims Issues. Finding and fixing claims process issues is hard work. Indeed, top level reports might indicate issues with a particular hold code or denial reason, but finding claims with that hold or denial reason that can then be used to support root cause analysis of the underlying issue is typically a signicant barrier.
• Improve Configuration. Configuration can be tough to track once set-up. ClaimFetch makes it easy, before claims have been paid and after to review them and find configuration gaps early.
• Increase Provider Relations. Providers call and ask about claims. Some describe 'denial' or other claim issues. With ClaimFetch provider reps can look up claims on the spot -- individually or in groups -- to validate provider concerns.

Innovation, Flexibility, and Scalabilty

How does the ClaimFetch work? It works by combining two core data technologies with an easy to use web-based user interface. First it loads open and closed claims data each day and applies a set of business rules to each claim. (Would you like to see the rule used to determine duplicate claim lines?). Second, it loads the individual claim data into a search engine (claimfetch) that enables users to search on indivual and sets of claims (Would you like to see 100 random claims that were denied as duplicates for that provider?).