How Health ClaimsRef serves your needs
Process claims efficiently and save money
Use a standard system of checks to avoid errors and omissions. Quickly identify unwarranted or excessive services.
Build client capacity
Add value for clients with your reinsurance support. Enable efficient and consistent practices for your clients.
Optimize rules-based automation
Simplify and streamline digital practices in your region to support benchmarking and future analysis for clients. Our rules also help ease the integration process and avoid delays.
Milliman Health ClaimsRef benefits
Increase efficiency
Preauthorize claims with automated checks and reduce unwarranted use of expensive clinical resources. Settle clean claims quickly without time-consuming negotiations.
Improve quality of processes and personnel
Promote standardization and uniformity in your business practice with tools that are easy to implement. Support training of claims team members with built-in tools.
Discover and correct errors and omissions early
Flag potentially incomplete, excessive, or fraudulent claims for manual intervention by applying our guidelines and rules upon receipt of claims.
Milliman Health ClaimsRef features
Web-based portal
Access hundreds of guidelines for common and high cost inpatient medical and surgical conditions from any device, wherever needed.
Practical and pragmatic rules
Use rules based on in-depth clinical experience, specific to your region, and designed especially for the claims adjudication process. The solution is supported by published research and market validation.
Supported, customizable approach
Rely on the experience of a clinical team of doctors and actuaries with global experience and awareness of regional practices and codes. Adapt and configure rules to specific insurance products and local coding systems.
Consistent maintenance
Expect seamlessly integrated updates and enhancements from Milliman to keep current with trends in your region.