CASE STUDY 3
CLAIM STATUS
Client:
RCM firm working on behalf of southeast health system with 1,000+ beds
Challenges:
- Excessive number of phone calls and web lookups to obtain claim status
- Incorrect patient information including member ID
- Implement touchless transactions to reduce labor costs
Solutions:
- Delivered Extended X12 Claims Data for major payers like Anthem BCBS (14 states), Humana, United Healthcare and others to avoid phone calls and web lookups
- AI Pattern Analyzer detected and corrected inaccurate patient information that otherwise would have led to unsuccessful claim status responses
- Trigger response mechanism placed accounts with certain statuses in a future work queue
Results:
- Depth of claim adjudication information includes allowed amount, patient responsibility and actionable denial descriptions, which creates a framework for touchless transactions
- Successful claim status response rate increased by 25%
- Eliminates current touches and focus labor on resolving high value claim denials