Revenue Management - Claims Handling
Effectiveness and efficiency of operations
A. All claims are handled on a timely basis.
- Are claims personnel provided with the information required to research and resolve claims at the initial point of customer contact?
- Have processes been implemented to facilitate timely communication of claims decisions by billing and service personnel so the claims can be promptly processed and reported?
B. Claims strategy is aligned with marketing and financial strategies.
- Is the University's claims experience examined periodically to ensure service performance remains consistent with the claims period and marketing strategy?
- Is it required that financial and service delivery personnel consider the financial risks of claims programs by factoring in their impact on total service life cycle costs?
C. Relevant information is used to eliminate underlying causes of claims.
- Is cross-functional communication promoted between service delivery and marketing personnel about the nature and extent of claims and their underlying causes?
D. Useful information about the reasons for claims is obtained from the claims handling process.
- Are customers asked to submit requests for claims on standardized forms that include fields for indicating the reason for the claim and any other comments?
E. Claims are properly authorized.
- Is the validity of the customer claim validated and are both the terms for all claims and the proof of refused services verified before approving the claim and recording the claim transaction?
- Are all customer claims assigned a unique reference number in the claims system for identifying the transaction and tracking the disposition of refused services?
- Are all claims identified separately in the claims system using detailed descriptions of the claim background (for example, the service description and code, reference to the original service order and invoice, reference to the original receipt and customer signature, the customer's claim, and the action taken)?
- Is an indicator built into the invoicing system and accounts receivable system to signal a claim has been made and is being processed to prevent duplicate submission and processing of the same claim transaction?
- Are the quantities and descriptions of refused services checked automatically against the original service delivery records during the credit processing function?
- Are computer routines applied that automatically post the credit to the appropriate financial records based on amounts originally recorded on invoice records and price master file records?
- Have controls been implemented to maintain the integrity of the programs used to process
transactions? Include controls such as requiring authorization for all changes to
program routines and limiting access to these systems to
prevent unauthorized credits.