In 2003, getting a document signed by multiple parties across different organizations meant printing, mailing, waiting and hoping nothing got lost. Today, DocuSign processes more than one billion transactions annually because it has made a painful multiparty process simple for everyone: signers click a button, initiators track progress in real time and compliance teams get automatic audit trails.
Unfortunately, current healthcare claims management and reimbursement processes remain stuck in 2003–inefficient and delayed. Providers wait 30 to 45 days for reimbursement, payers spend up to 12 days processing claims and patients often wait weeks to understand their financial responsibility. The solution to this isn’t more staff or better fax machines; it’s a real-time platform that benefits patients, providers and payers simultaneously.
Providers should be able to focus their time and resources on delivering high-quality care to their patients. Instead, they often face an overwhelming maze of thousands of insurer contracts, prior authorization requirements and reimbursement schedules, none of which are in systems that can communicate with each other. Multiply that complexity across dozens of payers, and large provider teams are required to spend countless hours navigating this maze. The result? Providers spend billions of dollars and far too much time just trying to get reimbursed for services provided, with average payment cycles stretching to 51 days.1
Payers face their own challenges. They have an obligation to prevent healthcare waste and abuse, implementing necessary guardrails to protect the system. But while these controls are essential, only 5% of reviewed cases involve abuse.2 That means the vast majority of providers experience friction due to problems they didn’t create.
The resulting cost to patients is significant. Nearly one in five Americans receive an unexpected medical bill each year, often for services they believed were covered. Patients are forced to navigate financial obstacles at their most vulnerable moments.
DocuSign proved that multiparty approval processes can be fast, transparent and secure. Healthcare’s claims management system is overdue for the same transformation.
The Future We Need: Real-Time Solutions
Just as DocuSign revolutionized contract signing by creating transparency and speed for all stakeholders, healthcare, too, needs a unified solution that makes the claims process simpler, faster and more transparent for everyone—one that can absorb the intricacies of every insurance contract and regulation. A solution that provides real-time answers about coverage, provider reimbursement and patient responsibility before the first procedure begins.
Real-time claims decision-making could bridge the gap and ease administrative burden significantly. While that idea isn’t new, we now have the technology to make it a reality. Advances in generative AI and large language models mean that technology solutions can quickly and accurately analyze the tens of thousands of payer contracts and make decisions in real time.
What the Future Looks Like for Healthcare Stakeholders
Giving providers that tool would allow them to reimagine the process of providing care. The claims management and reimbursement process (which includes the claim review, determination and final billing) can take anywhere from 24 hours to four weeks. This communication roadblock between providers and payers leads to multiple delays in processing claims.
Instead, now imagine that while sitting with a patient, the provider could automatically query the payer in real time to understand if a procedure would require a prior authorization and, if so, automatically pull the appropriate information from the chart and submit the prior authorization request in that moment.
In turn, this would simplify and clarify the patient’s experience considerably. Before the patient leaves the room, they would know that their prior authorization is approved, understand what they owe and may even have their procedure scheduled.
And payers would have the accurate and real-time information they need to process claims and issue the right decision immediately. Today, 12% of claims are rejected due to administrative errors; the time and financial costs of having to re-review claims are substantial, and the re-review creates a delay in care that could be avoided. Real-time data would drastically reduce denials, as well as the costly administrative processes necessary to reconsider denials once additional context is provided. Ultimately, this would enable payers to refocus resources on what matters most: improving care delivery and health outcomes for patients.
Now is the Time
Healthcare cannot continue to be the only industry in which the consumer doesn’t know what they’re going to have to pay before purchasing the service. The stakes are too high. We owe it to people who are already dealing with a lot of uncertainty in their healthcare journey to remove as much financial complexity and uncertainty that we can.
Real-time healthcare infrastructure is needed right now. A healthcare experience with ease and clarity is possible, and some of the brightest minds in the industry are responsibly leveraging advanced technology to make it a reality. Connecting patients, providers and payers will reduce friction and improve health outcomes—helping to transform healthcare from denial management to denial elimination. It’s the next step needed to restore trust in healthcare.
Puneet Maheshwari serves as senior vice president and general manager for Optum Real
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