Leveraging one’s data literacy skills allows one to identify the various use cases to grow revenue, reduce costs, or manage risks for successful Data Monetization. Healthcare is an industry where Data Literacy and Management has been constantly growing and maturing due to the state and federal mandates to support a Health Insurance Payor’s member.
Health Insurance Payors understand that members have a great deal of options to choose from when selecting their carrier year over year; many companies anchor their business motto on the member experience. This translates to Health Insurance Payors striving to excel at marketing, claims management, member appeal process efficiency, and ensuring that members are reaping the benefits provided to them through state and federally mandated regulations. Some examples where one may find that the organization’s mantra of improving the member’s experience may be impacted follow.
- Improper claim denials due to invalid or incorrect provider NPI, or perhaps the providers are not credentialed accurately, and out-of-network charges are applied for in-network providers may increase member appeals
- A member’s physical address changes to a nearby state, which is still within the insurance payor’s jurisdiction. The member may suffer from a medical condition that has specific mandates for care depending upon the state where the member resides. If the address metadata is not accurately captured or updated timely, the member may be denied claims for medication, supplies, or services that would otherwise be covered in adherence with the state mandates.
Working together, Definian can review your organization’s priorities, identify monetization opportunities, and corroborate use cases that resonate with business, leadership, and technology teams. We will work with you to leverage and expand your data literacy by considering possibilities such as complying with state and federal regulations related to provider credentialing, promoting growth initiatives through member data quality improvements, or reducing administrative costs by retiring or sunsetting applications and reports that have reached the end of their useful life.
Our team will help your organization trace the value of your data from use cases through business drivers to quantify the value of your program, affording you the opportunity to showcase your Data Monetization Investments. Reach out to us today!
