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EDM and healthcare claims

This article on b-eye network caught my eye this morning - Using Healthcare Business Intelligence to Improve Revenue Management. In it Scott Wanless makes some great points about why the healthcare claims arena is a mess. Among the issues he identifies:

  • Complicated rules
  • Ever-changing rules
  • Pressure-cooker situations
  • Lack of critical information

These are indeed the four drivers we see for healthcare providers to start adopting EDM technology. Complicated, numerous, ever-changing rules mean that a business rules management system is a key component in implementing claims management software. The pressure-cooker means that decision automation is key - you simply cannot have a manual process. The lack of critical information drives rules-driven data collection and validation as well as interactive "Smart Forms" to capture and revise data.

While I agree with Scott that BI can help you identify and manage the problems this process causes for you, only an EDM approach to automating claims management is going to solve the problem.

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