Legacy Systems Create Inefficiencies
According to Info-Tech Research Group, legacy adjudication systems remain a source of financial strain for healthcare insurers. Outdated platforms often lead to:
- High claim holds caused by coding errors, missing data, and incomplete documentation
- Heavy reliance on manual processes that increase errors, delays, and costs
- Significant financial losses, with research showing that up to 15 cents of every healthcare dollar is lost to inefficiencies
- Rising compliance requirements and data security concerns that legacy systems cannot adequately address
These issues contribute to delayed reimbursements, inflated administrative costs, and resource diversion from patient care.
Structured Framework for Modernization
To address these challenges, Info-Tech has released Modernize Your Claims Adjudication System: A Buyer’s Guide. The report provides IT and business leaders with a structured framework to evaluate modernization options, assess vendor solutions, and build a business case for transformation.
The guide presents a phased roadmap for insurers:
- Phase 1 – Identify Industry Trends and Shifts: Executives and compliance leaders review regulatory changes, technology advancements such as AI and machine learning, and market conditions.
- Phase 2 – Define Business Needs and Capabilities: Stakeholders determine key capabilities, including automation, analytics, fraud detection, and support for value-based care.
- Phase 3 – Analyze Features and Vendors: Procurement teams and architects compare vendor solutions, evaluate interoperability, and select the most suitable system.
The report also introduces vendor evaluation tools, weighted criteria, and RFP templates to support decision-making.
Expert Insights
“Claims adjudication is the heart of the insurance business, yet too often it is powered by aging infrastructure,” said Sharon Auma-Ebanyat, research director at Info-Tech Research Group. “IT and business leaders need to treat modernization as a strategic initiative, not a back-office upgrade. Info-Tech's structured buyer's guide helps insurers weigh vendor offerings, reduce risk, and deliver systems that are more accurate, compliant, and cost-efficient.”
About Info-Tech Research Group
Info-Tech Research Group is a global research and advisory firm serving more than 30,000 IT and HR professionals. For nearly 30 years, the organization has provided actionable research, tools, and analyst guidance to help leaders make strategic, well-informed decisions.
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