Skip to main content
Automated claims processing

Milliman Health ClaimsRef

Minimise errors, processing time and costs with rules-based technology-solution.

The challenge

Inconsistent claims processing increases cost and risk

Waste and inefficiency cost insurers billions of dollars each year. Without proven data structures and well-defined processes, excessive and unwarranted services go unchecked. However, claims processors face time limits on claim settlement, making it challenging to perform detailed analysis. Rapidly evolving medical practices and non-standardized claim codes further complicate their work.

The solution

Use rules-based technology to improve claims processing accuracy

Combining clinical knowledge and decades of experience across a wide range of projects, Milliman Health ClaimsRef applies configurable business rules to manage health claims accurately and efficiently. Data and learning from multiple geographies ensure that the rules are both evidence-based and locally relevant across most jurisdictions. Milliman Health ClaimsRef is easy to integrate with existing claim systems and can be used to automate claims processing.

Explore our guidelinesNavigation Arrow
Supporting insurers, reinsurers and system integrators

How Health ClaimsRef can help

For insurers and third-party administrators (TPAs)

Automate your claims processes to save time and money

Easily implement a standard system of checks that reduces errors and omissions during claims adjudication. Quickly identify unexpected, unwarranted, or excessive services and reduce waste.

For reinsurers

A unique solution for your clients to reduce risk

Offer your clients an efficient and consistent framework for claims processing.

For system integrators

Optimize rules-based automation

Enrich your offerings by integrating our comprehensive set of claims processing rules. Fast, efficient deployment based on our in-depth experience and best practices supports rapid return on investment for your clients.

Benefits

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.

FEATURES

Milliman Health ClaimsRef features

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.

Web-based portal

Access hundreds of guidelines for common and high cost inpatient medical and surgical conditions from any device and any location

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.

Continuous updates

Seamlessly integrated updates and enhancements from Milliman keep the rules, and guidelines fresh and relevant to your region.

INSIGHT

Related insight

Resource Card Placeholder
Article

Opportunities for cost savings—healthcare claims management in India

With an urgent need to bring cost inflation into a sustainable range, we examine best practices in reducing spending, while maintaining or improving patient outcomes.

Read the articleNavigation Arrow
Resource Card Placeholder
Article

Four levers of controlling health claim costs

With the ongoing COVID-19 pandemic, it has become all the more important for insurers to manage their claims and expenses.

Read the articleNavigation Arrow
Resource Card Placeholder
Article

Changing gears for changing times: Population health analytics and India's health insurance industry

Sophisticated population health analytics enable insurers to make smarter and more informed decisions on financial trend drivers, and can help medical management departments by more effectively allocating disease and care management resources.

Read the articleNavigation Arrow
SERVICES

Services related to Milliman Health ClaimsRef

Resources

Milliman Health ClaimsRef resources

Brochure

Milliman Health ClaimsRef brochure

Minimize errors, processing time, and costs with a rules-based technology-solution.

Download PDFDownload

We’re here to help

Ask the tough questions. We’re ready for them.