Medical Claims Management

Medical claims management is the process by which insurance payer companies assess claims and determine their validity and the extent of coverage. Software for medical claims improves the speed and efficiency of the entire process of claims management in healthcare. This is possible through automation. Automating all the repetitive and manual tasks increases the overall speed of healthcare claim processing and decreases mistakes. In other words, increased speed and reduced mistakes ultimately result in greater productivity. As a result, fewer, if any, fraudulent claims are getting approved.    

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Claims integration is the best way to provide automated and easy access to their health records and medical claims in one place. Healthcare claims management is a highly complex process. It can be made simple by customized medical claims processing software with the claim integration system. Tailored medical billing systems with claims integration allow easy access to a digital archive of all the records, including medical, dental, prescription, and vision services in the USA.

OSP’s solution to claim processing system in healthcare can help you to track bills, payments, and annual deductibles automatically. We customize billing claim medical software to simplify quality control maintenance, to maximize productivity & compliance. Multiple models of claims integration with patient accounting make our tailored claims software solutions comprehensive and flexible. Our Tech experts in the USA engineer claim management solutions with claims integrations for claim submission to payor notification dates, payor acceptance, and rejection data, claims status, eligibility, ERA and denial information.

A medical claim billing software needs proficient claims review management to support the accurate coding of claims that result in fair, and transparent payment policies. An ICD-10-compliant medical claims management software that evaluates claims information helps providers in the USA to decrease the rate of denials. Top-notch claim administration software solutions have claim review management systems that include CPT/HCPCS procedure codes to identify coding errors and conflicts to make recommendations for correction for both professional as well as facility claims.

OSP can program health claims processing solutions with pre-configured coding rules. We create next-gen claim software solutions that provide the clinical foundation of rules and logic essential for intelligent claim edit results. Through medical claims management solutions, we strive to improve provider payment transparency by sharing claim edit rules, source data, and complete clinical rationale for potential claim edits with providers through your payer’s website.

Reporting is one of the most underrated yet essential modules in a working revenue cycle management system. To better your claims management healthcare solutions finding the common errors and mistakes is important. OSP can help providers in the USA with easy-to-use and intuitive reporting dashboards that help to visualize the most common reasons for claim denials and rejections. We customize the healthcare claim administration software to enhance your reporting capabilities and help you plug the revenue leakage across your revenue cycle.

We program health claims software with a customizable reporting system to analyze the claims data in your preferred format with a modern, wizard-like setup experience. Our tailored medical claims management system ensures robust data feeds to enable holistic claims understanding through a big-picture view of your data.  OSP can engineer healthcare claims management software with smart reporting to achieve real-time performance management and learn new ways to boost revenue. Through our made-to-order medical claim software, you can easily build your reports to make cash forecasting and productivity management.

Electronic Data Interchange (EDI) is the sending and obtaining electronic data using technology. For claims submission, a standalone EDI system is required. Especially for an 837 file that contains patient claim information. For billing and claims management, good quality EDI system allows you to quickly and easily automate the claims processing. It helps in minimizing revenue leakage, boosting clean claim rates, and drive down unproductive manual systems.

We customize medical insurance claims processing solutions with next-gen EDI systems the can process millions of enrolments, medical claims, and other EDI transactions across the USA quicker than any manual system or clearinghouse. Health claims management process is made compliant by implementing the SNIP levels 1 – 7 and getting CORE CAQH compliance. The flow of your EDI can be easily monitored, controlled, and maintained with executive dashboards, smart analytics, and databases, making your healthcare claims management system full proof.

Medical Claims solutions require claims status management to automate the follow-up process for commercial payers by accelerating the provider’s timeline for receiving payment while reducing the cost-to-collect. It is a highly time-consuming and complicated process, made further difficult with limited access to claims adjudication status. By automating the claims status management, the manual claims status checks can be eliminated in medical claims management.

OSP can engineer healthcare claims software that automates the claims status management by retrieving the claims status data from the payers and generate a list of approved, rejected, and denied claims.  OSP’ made-to-order medical claim processing Solution in the USA helps to eliminate the efficiencies of manual status searches to gather more actionable details. Our custom medical claims management healthcare solutions help to lower A/R days resulting from denied or unpaid claims not being worked in time. By streamlining the claims status management, OSP’ custom-made claim administration software solutions prove highly beneficial for providers in the USA.

Traditional medical insurance claims processing software requires manual payment postings wasting time and resources that can be utilized on primary processes. An automated remittance management module in claims management software help to manage the entire remittance process and streamline downstream processes to save time and money. Our medical claim management with top-notch remittance management helps you retrieve and capture every ERA transaction from the payors in the USA, eliminating the time-consuming follow up when files are not available.

OSP’s claim management solutions stand to resolve issues created by inconsistencies across payor ERA files. It eliminates the need for manual correction often necessary after automated posting processes are complete. Remittance data is posted through batch or key emulation capabilities, including final payments and contractual adjustments, as well as patient liability information and reason codes. Following up on outstanding payments and remittance advice is made easy with our tailored medical insurance claims software solution.


An insurance company would deal with dozens or even hundreds of claims each day. In light of this, some are bound to be fraudulent but still get approved. Estimates show that insurers lose several million dollars to such claims. However, the claim management software that OSP can build will improve the efficiency and accuracy of the claims assessment process. As a result, it will become easier for payers to detect suspicious claims and reject them.

Software for healthcare claim processing accelerates and optimizes the entire process of claims management significantly. This means that payers can assess a higher number of claims each day without any increase in their staff strength. In other words, claims processing software enables them to do more with less. By increasing productivity without an increase in overhead, claim processing software ultimately results in higher payer revenues.

Due to several unforeseen factors, processing claims can take longer than expected. These delays can sometimes result in delayed treatments, leading to adverse consequences for patients and anxiety. But a claim management solution streamlines the process of analyzing claims, resulting in faster payment decisions. Needless to point out, patients can avoid the stress and anxiety of slow processing.

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