Claims Management

It is imperative for a payer organization to increase its health insurance claims processing automation and reduce administrative costs. WAPMED offers end-to-end world-class health insurance claims processing solutions to help manage the claims effectively.

Use of Information Technology in the insurance domain maximizes customer information and optimizes channels to serve the customer better. WAPMED team has undergone intensive training suitable for the insurance industry and its products. They are trained to handle a high-pressure environment and understand the significance of real time monitoring and feedback.

Our services strive towards complete implementation of automated end-to-end process flows until the claims are successfully resolved.

WAPMED has a team of medical professionals and the technical staff to handle the claims management for the members enrolled. The computerization of claims processing has laid the foundation for WAPMED to deal in large volumes of claims. The auto-adjudication of claims reduces the manual intervention to a large extent and greatly enhances the speed of processing.

The IT network enables the clients to access the status of claims, electronic submission etc. Latest addition to WAPMED’s highly sophisticated Claims application is “Multicurrency Platform” which enables WAPMED to manage complicated claims wherein Billed currency, Policy currency and Payable currency are different, without manual intervention.The objective of the present medical scrutiny done at WAPMED is to identify some of the points listed below.

  • Inappropriate billing pattern.
  • Detection of customary overcharges.
  • Duplicate billing detection.
  • Visiting Doctors charges.
  • Fee schedule.
  • Verification of pharmacy and investigation bills for reasonableness.
  • To filter unnecessary admissions.
  • To monitor length of stays.
  • Necessity of hospitalization.
  • Every processed claim undergoes a 22 stage internal audit process.