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Solve Medical Claims Processing Issues with Outsourcing

By January 9, 2023April 14th, 2024No Comments
Healthcare medical claims processing outsourcing blog

Medical/insurance service providers need to assess many medical codes. It helps them determine reimbursement. Therefore, medical claims processing involves a dozen steps. There are ways to ensure accuracy and improve efficiency for this complex workflow. The most utilized solution is outsourcing medical claims management services. Medical claims processing companies can streamline the entire process.

The pandemic has pushed significant growth in the healthcare and insurance industry. It has made more companies getting medical claims processing services from BPOs. Companies always prefer an experienced medical business process outsourcing company (BPO company) to take care of their medical claims management. But there may be some issues with claims processing services by a BPO provider.

Let’s learn about these medical claims processing issues:

Medical Claims Processing Issues with Outsourcing

1. Navigating Medical Codes

There are unique medical codes that describe different things medically. This includes healthcare services, corresponding diagnosis codes, procedure codes. It also includes date of service, attending physician’s National Provider Identifier (NPI) number, charge for the service, and many more. It is crucial to go through each detail to process the bill correctly. This must be done within a specific time period.

2. Confidentiality and Data Security


The concept of data security and protection against a security breach is a concern. It evolved with technological development. Therefore, thorough research about which healthcare BPO provider to hire is vital. Unauthorized disclosure of data or information about a patient is forbidden. It violates the act of confidentiality and data privacy.

3. Miscommunication to Know About Claim Processes

Team Composition

Clarity of processes and concepts is important for any business partnership. Miscommunication between the medical outsourcing service provider and the facility can cause problems. It may lead to insufficient access to necessary information. This can raise many internal and external issues.

4. High Expectation

Some medical facilities may have extremely high expectations from their BPO service partner. They look at how experienced the teams in the company are before hiring them. They also learn the project management teams and team members’ roles in medical claims processing.

5. Organizational and Cultural Barriers

Globally progressing medical and insurance providers need a great pool of talent. They may also need offshoring services. They may have to go through corporate and regional barriers. Such differences can influence productivity. 

6. Low Accuracy

Data entry accuracy is crucial for claim processing. Medical facilities may encounter issues if data accuracy is compromised. A BPO service provider needs to be efficient enough to provide the best data entry services.

ARDEM's Support in Medical Claim Processing

All the issues listed above can easily be resolved by an experienced BPO company. One of the leaders in the industry is ARDEM. Let’s learn how outsourcing with ARDEM can solve medical claims processing issues.

1. Precision and Efficiency

Speed and Efficiency

ARDEM specializes in medical claims processing. We address the complexities efficiently. These include decoding unique medical codes, verifying service dates, and cross-referencing attending physician NPI numbers. ARDEM ensures accurate billing within stringent timelines. We mitigate errors and optimize efficiency for healthcare providers.

2. HIPAA Compliant

We implement a slew of security measures to protect your data.

The outsourcing partner must comply with strict data regulations. It will ensure maximum data protection. ARDEM complies with the Health Insurance Portability and Accountability Act (HIPAA) regulations. With this highest level of security protocol, our clients are assured about data security.

3. Dedicated Project Management

ARDEM serves its clients with dedicated project management. The project manager is the main point of communication between the client company and their team. We fully understand the project. So, ensure the smooth completion of the project.

4. Fully-Enhanced Workflow with Years of Experience


ARDEM has experience of 20+years in providing business process outsourcing solutions. We combine the best people and robust technologies. Thus, we deliver success to our valuable clients. We have a diverse talent pool. Our clients can benefit from talents from across the globe.

5. High Accuracy

ARDEM provides medical claims data entry services with the facility of automation. So, our clients can expect high accuracy of up to 99.7%. It is applicable in our data entry and data processing services. It helps to decrease cycle time and administrative costs.


Medical claim processing involves navigating through various challenges. This includes data accuracy, confidentiality, and communication issues. However, outsourcing to experienced BPO companies like ARDEM can effectively address these challenges. ARDEM serves as a reliable partner in streamlining medical claims processing. Thus, we ensure efficiency in healthcare operations. Reach out to ARDEM for more information.