Facing Insurance Claim Adversity

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What is Payor-Provider Adversity?

Payor-provider adversity is rooted in the dreaded topic of insurance claims. While payors (i.e., insurance companies) are incentivized to minimize the claims they pay out and delay payment, providers (i.e., clinics) rely on timely claims processing. This puts the two parties on opposing ends of the problem, and technology for providers has proven to be the one factor able to level the playing field. 

While payors have long been employing the best minds in the business to create processes and develop automated systems for catching errors in claims to reduce payout rates, providers are still trying to get a leg-up by finding the right software to implement. Here’s a look at how a solution like ClinicMind can help your practice achieve greater fluidity. 

The Relationship Between Claims Processing and Success

All practices rely on timely claims processing and payments in order to keep their business thriving. When claims are delayed or denied, practices experience income disruption and they directly suffer as a result. However, given the complexity associated with filing a claim properly, substantial administrative resources are invested in the process.

As payers continue to implement more sophisticated systems to find errors in claims, providers have struggled to strike a balance. It only makes sense for providers to turn to sophisticated technology to identify errors in their claims before the insurance companies do. Investing more time in claims processing takes time away from patients and other important processes but failing to file claims properly will lead to financial upset. That’s why more are turning to software to ease the burden of claims paperwork. 

How Does Software Support Claims Processing?

For providers, software like ClinicMind supports key business goals by:

  • Reducing the amount of time necessary to file a claim properly, thereby improving the chance of timely acceptance and payment. 
  • Empowering clinic staff to spend less time on paperwork and more time providing exceptional patient care.
  • Providing a steadier flow of business income, allowing the practice to invest in patient care and new patient intake.
  • Analyzing the claim against all known historical claim errors from over 72 million claims to reduce the chance of claims being denied or delayed without someone having to comb through each claim manually.

When the right software is in place to support claims processing, a practice is given a strong foundation on which to grow. Compare this to a practice without a solid software solution in place.

For practices without a solution like ClinicMind, they are encouraged to take on as many patients as possible to increase earnings, but each patient visit puts additional strain on the team administratively. 

More patients also equate to more claims, which in turn, creates more work and a higher risk of denial. Too many denials can cause further business disruption — for instance, government payors like Medicaid and Medicare can revoke a practice’s license if too many claims have errors. 

Simplifying Claims Management

With ClinicMind, your practice can reduce the amount of time spent filing claims and reduce the chance of errors. In turn, your business will have more claims accepted with fewer denials or delays, supporting your overall business goals.

Since ClinicMind offers custom workflows, it’s also capable of streamlining other business processes. As a result, ClinicMind gives your staff more time to spend with patients and reduces the back-office workload. Meanwhile, patients enjoy better care and providers have more time to devote to new patient intake.

Best of all, ClinicMind is one of the only solutions of its kind, offering a sophisticated system that adapts to your ideal workflows instead of requiring your team to re-learn vital processes. Interested in learning more about how ClinicMind can support your practice? Reach out to our team to learn more. 


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