Gartner Research

Healthcare Payer CIOs: Make Claims Logic Transparency a Differentiator, Not a Disadvantage

Published: 01 March 2018

ID: G00347642

Analyst(s): Mandi Bishop

Summary

Customer-centric affordable care demands a high degree of transparency between payers and providers, yet claims logic is often purposefully inaccessible. CIOs must champion claims processing logic transparency to avoid the preventable claims denials that diminish reputation and revenue.

Table Of Contents

Analysis

  • Avoid Preventable Claims Denials to Achieve Revenue and Savings Goals
    • Ninety Percent of Claims Denials Are Preventable
  • Recommendations
    • Identify Claims Denials Accountability Gaps
    • Shift the Paradigm: Deny Fewer Claims, and Improve Financial Performance and Growth
    • Implement Claims Logic Transparency to Avoid Preventable Claims Denials
    • Quantify Your Transparency Initiative's Results

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