How Health ClaimsRef can help
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.
A unique solution for your clients to reduce risk
Offer your clients an efficient and consistent framework for claims processing.
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
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
Consistent maintenance
Expect seamlessly integrated updates and enhancements from Milliman to keep current with trends in your region.
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.