UMH is a system for managing patient claims on behalf of insurance companies. The system was first used in the United States for the administration of Medicaid, but it is now being used in other health care sectors for the management of claims, reimbursement and benefit delivery. The UMH system allows multiple payers and health care providers to collaborate for cost control by sharing claims data between them. The good news: today's technology enables the administration of UMH to affect significant changes to the structure and functions of the insurance industry.
The UMH system creates a new model of utilization control (UCH), shifting the balance of decisions from claims processing to post-claim decision making. Claims processing in UMH is done via a claim submission module that can be integrated with third party claim processors. The module collects medical information from patients and sends it to third party claims processors who make post-claim decisions on behalf of the insurance company. Once an agreement is reached between the third party processor and the insurance company, the processor submits the claims, which are then submitted to the insurer for processing.
This process is made easier through the use of software tools, which are built around the concepts of client-server UMH. Client-server applications are designed to collect the information and then make it available for decision-making, where decisions are then made on behalf of the insurance company. These are typically based on claims submission modules that use complex mathematical algorithms to identify which claims are valid and which are not, and which claims to have potential for reimbursement or elimination. They then compare these results to information provided by the third party claims processor and determine whether the claim should be denied or approved.
Claims processing in UMH allows multiple providers and multiple insurers to share and submit claims at the same time, thus reducing costs for the entire health care organization. When multiple providers submit claims at the same time, the insurance company does not have to hire an entire claim processor team, and instead can use claims processors and software to perform the processing on their own.
This increases efficiency in claims processing, which means . . . . . . that there are less paperwork to process and less time spent on paper. In addition to saving time and money, it also helps reduce risk and fraud in the health care sector. By using claims processing in UMH, the insurance company avoids spending time and money processing claims, and having to spend money on claims-related legal expenses.
The UMH system allows the insurance company to take control of the process of claims and to provide better care to their policy holders by controlling claims and reducing the amount of paperwork. by automating the entire claim processing process.