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Related Experiment Videos

Will on-line adjudication fit the need?

F Bazzoli

    Health Data Management
    |December 9, 1994
    PubMed
    Summary

    Online claims adjudication offers immediate, paperless healthcare payment determination, potentially saving costs. However, physician adoption and the rise of managed care plans pose market challenges for this technology.

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    Area of Science:

    • Health Informatics
    • Healthcare Administration

    Background:

    • The current healthcare system faces inefficiencies in claims processing.
    • Paper-based claims result in significant administrative overhead and delays.

    Purpose of the Study:

    • To evaluate the potential benefits and challenges of on-line claims adjudication in healthcare.
    • To assess the feasibility and market viability of immediate, paperless claims determination.

    Main Methods:

    • Analysis of proponent claims regarding cost savings and efficiency gains.
    • Examination of skeptic concerns about physician adoption and market dynamics.

    Main Results:

    • On-line claims adjudication promises immediate, paperless determination of financial responsibility for healthcare services.
    • Potential benefits include significant cost savings through reduced paperwork and increased efficiency.

    Conclusions:

    • Physician adoption remains a key question for the success of on-line claims adjudication.
    • The growth of capitated managed care plans may present a significant market challenge, potentially limiting the demand for on-line claims processing.

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