With the continuous changes in the software industry, claims management systems (CMS) have evolved with technology. These systems are equipped with newer capabilities to provide enhanced services to customers. In such situations, evaluating and selecting the right CMS for your organization could be a difficult task. To help you with this process, we have provided some simple steps through which you can evaluate and choose the right CMS for your organization.
Check the efficiency and responsiveness of the system:
Efficiency
• Complaint management systems are crucial to satisfying customers and improving overall business performance. A CMS should be able to manage the entire claim process, from start to final settlement. The software should help organize each file activity and keep reports.
Sensitivity
• In addition to performance, a CMS must allow the user to run reports instantly. The ability to quickly access information will expedite claims, allowing employees to return to work and saving employers valuable resources.
• A transaction: access and save a claim, create letters, etc. It shouldn’t take more than 10 seconds, and on average it should only take a couple of seconds.
• When evaluating CMS performance and response time, be sure to check it in a real-time environment with user data. This will give you a complete picture of system performance and responsiveness.
Technology used in the system.
Many organizations today prefer browser-based systems that help simplify deployment, support, and enable remote access.
• When evaluating technology, check the type of database being used. It is important to choose the right database with a simple and efficient data model. This will help create reports and extract data independently.
• A critical issue that many organizations do not control is the reporting database. The reporting database should be kept separate from the transactional database as it affects system performance.
Security, confidentiality and system hosting model
Data security and confidentiality
It is the organization’s responsibility to keep claimant information secure. To keep data secure, it must be encrypted with multi-level access passwords. All users should be given unique IDs and passwords without plain text.
• To reset the password and protect system security, do not allow the old password to be viewed.
• The data for the user and the user must be encrypted using SSL encryption. Along with this, user access permissions, authority levels, hierarchy, etc. – are necessary to ensure security and confidentiality.
Accommodation
• If your organization has adequate bandwidth and infrastructure to support new applications, you may consider hosting the system.
• If not, the best alternative is to hire a reputable web host. Be sure to confirm that the system is always accessible and compatible with no interruption in services. Also, when choosing a web server, make sure there is equipment redundancy and document backup to ensure data is replicated without loss.
System functionality and features.
functionality
• For each CMS, there should be some basic functional modules, such as claim/claimant maintenance, notepads, journals, reports, payments and reservations, etc.
• Check out functionality that will help examiners focus on closing claims quickly. You can ask various questions about the functionality of the CMS, depending on your business requirements and workflow.
Characteristic
• Consult the characteristics of the system and all the categories of data that your organization needs.
• The system must allow users to create data fields as the organization grows and risks become more complex.
• Check software integration. This provides new capabilities to resolve claims quickly and efficiently.
Supplier Evaluation
Once the system meets all the required guidelines, it is necessary to evaluate the supplier. To evaluate a provider, several factors must be considered.
Customer needs
• An efficient provider must constantly work to improve the system, based on customer needs. They should be to discuss new functionality and any challenges with implementing system enhancements. Ask any potential vendor how often they meet with their clients to discuss these issues.
Other factors (past experience, etc.)
• Consider the previous experience of providers. How efficient are they in the research and development of new technologies? How effective are they in knowledge transfer?
• References would help in choosing the right web host. This will provide an adequate vision of what the relationship with the supplier will be like in the future.
pricing structure
• The price structure must be flexible for each client. Depending on the size and need, each contract can vary greatly. Payment terms must also be flexible to allow companies of all sizes to find a system that works for them financially. A CMS with many users should cost less per user than one with fewer users.
Following these points can help you assess the quality parameters of the claims management system (CMS) and verify how well it fits your business.