Claims Accuracy Matters, and Enkata Delivers Meaningful Accuracy Improvements

Dan Enthoven's picture

Healthcare claims payers know that accuracy is critical.  Underpayments cause complaints and rework. Overpayments may never be caught. The Enkata employees performance optimization solution helps claims payers achieve substantial accuracy gains in the following ways:

Correcting Problem Behaviors – Certain employee behaviors are highly correlated with high error rates.  One of the worst of these is what we call target shooting.  Employees with this behavior work at a very fast pace to get their quota for the day done so they can slack off.  These people often skip key steps and don’t use the level of care expected of them.  

Another problem behavior is multi-tasking. Some people drop whatever they’re doing every time an email or instant message shows up, up to hundreds of times each day.  Slicing complex tasks into dozens of two minute blocks is no way to work, and the result shows up in lower accuracy scores as well as lower productivity.

Enkata helps employees to correct these and other problem behaviors by identifying when they happen, and showing the impact they have. Managers can see how the people on their team work, and what specific changes employees can make to resolve the problem.  

Identifying Training Gaps – Some employees, especially remote ones, need more training than they are getting. Sometimes, the few days of new hire training just aren’t enough. Identifying when an employee needs supplemental training, and what training they need, can be very hard. However, Enkata can tell when employees are struggling with a particular claim type or task, and alert managers or the employees about specific training opportunities to improve quality.  

Process Optimization – Employers want to know which process is most effective, and which processes result in higher accuracy.  With Enkata, analysts can use detailed data about processor activities to answer questions about process and compliance.  Being able to see how each processor works, and the resulting impact on speed and accuracy, allows analysts to determine and enforce best practices for accuracy.

Enkata’s solution delivers the visibility and insight needed to achieve substantial accuracy gains on manually adjudicated health care claims. This same insight also helps health care payers achieve productivity gains of 10% to 20%, as employers can help their employees improve productivity as well as accuracy.  
For more info read our recent white paper “Improving Claims Processing Accuracy: Identifying and Eliminating the Causes of Errors.”