CASE STUDY 2
CLAIM STATUS
Client:
Radiology and Imaging Firm
Challenges:
- Data integrity issues with provider inventory file prevented full scale automation
- Allocation of accounts was inefficient due to lack of details regarding the current status of claims
- Contingency relationship between RCM firm and its client required extremely efficient resource utilization
Solutions:
- AI Pattern Analysis detected and corrected inaccurate patient and plan information in the inventory file
- API connectivity to claims data accelerated processing time of claim status requests
- Auto suggestions reinforced data handling to improve claim status success rate
Results:
- 7,204 out of 7,500 claim status requests returned successful responses
- 90% call avoidance
- Performance of denial team led to additional engagements for resources and technology services