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Health claims reimbursement journey: delays and confusion

Business question
Why do some health reimbursements generate so much confusion and so many contacts?
What's at stake
For a health plan with 200,000 members: 6,000 to 12,000 reimbursement-related calls avoided a year, or $43k to $86k in handling cost avoided.
Data required
Reimbursement request history (delays, amounts, rejection reasons), associated verbatims.
Sample result
Typology of rejections and abnormal delays, with the most affected care items.
Demo · 1 min
Illustrative scenario

Consider a health plan with 200,000 members. The analysis cross-references reimbursement claims, processing times, denial reasons and verbatims, and isolates the care categories and missing documents that drive the most calls.

MetricBeforeAfter
Reimbursement-related calls per year60,00051,000
Calls per 1,000 members per year300255
Handling cost of those calls per year$432k$367k
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