Claims Process Improvement Program

Project Overview

Part of Beacon’s strategy for continuous improvement is a transformative Claims Process Improvement (CPI) program, which began in early 2017. The program includes changes to several work streams designed to improve our provider experience:

  • Front-End Claims (Mailroom): Transition to a centralized shared-service process is well underway. While we encourage  providers to submit claims via electronic means, we also recommend to always verify claims mailing addresses prior to sending paper claims.
  • Data-Driven Management: Beacon is implementing improved data-driven management techniques to enhance metrics for  claims processing and operations.
  • EDI/Data Exchange: Beacon is improving the intake and processing of electronically submitted claims through the  implementation of a single gateway for front-end claims intake for all Beacon submitters. In addition, we will be implementing a centralized, shared-service process for validating and managing the exchange of data between Beacon and our trading partners.
  • Payment Integrity and Claims Analysis: Beacon has engaged Nokomis Health to provide us with analytical services related  to payment integrity and claims analysis. Nokomis employs an analytical claims engine to conduct this analysis and identify claims paid contrary to national and industry standards. As a result of these payment integrity efforts, providers may receive communications and documentation requests to verify claims submissions and payment accuracy. Additionally, Beacon may adjust claims errors identified as overpayments.

Important Documentation