To Build Or To Buy: How Orbit Changed The Insurance Capture System

Thursday, 8 August 2024, 2:43 pm
Press Release: Hugh Grant

To build or not to build is the question ringing in the minds of people wishing to take the first step into the world of insurance capture and benefit verification automation. There’s no time to lose in setting up this program as the cost of insurance errors and denials impact healthcare greatly.

$262 billion in insurance denials are lost per year, meaning roughly $30-$71 is lost per claim in additional expenses. Over 65% of denied claims are never reworked, although 66% are recoverable. Old systems of capturing insurance don't offer the tools needed to succeed. While they can help with card intake, image processing and extraction processes, they fall short of more advanced tools. These tools include accurately identifying payers and plans from images, routing and validating the payer, identifying coordination of benefits, and verifying insurance benefits.

It is clear that these old systems need to go, however, there are two ways to get insurance verification automation solutions. You can build them yourself, or partner with a professional in the related field. There are pros and cons to both.

The risks of building AI enabled insurance capture and verification systems are as follows; high upfront costs, high lifetime costs, time delays, complexity, and high risk for credibility. The high up front costs are a result of designing, building, testing, and implementing which can total to hundreds of thousands of dollars. The high lifetime costs are a culmination of maintenance, updates, fixes, and enhancements that can cost thousands over the life of the system – up to three times the cost of the deployment. Time delays are another factor as production may take years to develop, then more years as the system grows and matures – 6 to 9 months on the short end. Complexity is another possible issue where the system may be too complex to complete alone. IT takes a skilled team of IT professionals to build for payer routing, payer mapping, verifications, and more. The complex software has a cost disadvantage of 35%.

Finally there is a high risk for credibility where the builder cannot leave any room for error in terms of verification. 57% of customers will terminate business partnerships if a cyberattack occurs on account of faulty or under equipped software. There are many risks when considering building verification systems, however there are a few positives to note. The first is proprietary software in which your insurance card capture system is owned by you and you alone. The second is customization in which you can achieve specific outcomes by building specific workflows.

Buying a system may be a better option for individuals if having to build the system becomes too expensive. While there may be a multitude of partners in the market, if you don't evaluate the vendor upfront, you may not be satisfied with their speed or responsiveness.

This is where Orbit comes into play. Creating the best of both worlds, Orbit is robust and fully-featured, while also being future-proof and efficient. This system uses an AI model trained by domain experts on 4,000+ players and 20,000+ plans. Their algorithm validates information and verifies coverage in 5 seconds or less. With a dedicated team, low overall costs, no delay, and an intuitive design, Orbits system is paving the way for insurance card capture systems.

Deciding whether to build or buy an insurance capture and verification system involves weighing significant risks and benefits. Ultimately, the choice between building and buying depends on your organization's specific needs, resources, and long-term strategic goals. However, for many, Orbit presents a balanced and efficient alternative to the traditional build-or-buy dilemma.

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