CASE STUDY 1
CLAIM STATUS
Client:
Radiology and Imaging Firm
Challenges:
- Numerous phone calls to Anthem with transfers to other state plans for claim status resulted in low utilization of denial team
- Issues coordinating claim resolution with in state and out of state plans
- Length of time to work and resolve claims
Solutions:
- AI Pattern Analysis detected and corrected inaccurate patient and plan information in the inventory file
- Anthem Prefix Finder API indicated if member belonged to an Anthem state plan
- Additional claim adjudication detail resolved the mystery of missing documentation that resulted in a denial
Results:
- 88% call avoidance
- 5,219 out of 5,300 claim status requests returned successful responses
- Performance of denial team extended claim management engagement by 6 months