CASE STUDY 1
INSURANCE DISCOVERY
Client:
RCM Firm Specializing in Pathology
Challenges:
- Incomplete demographic information provided by hospital
- Time consuming process to verify insurance coverage for self-pay accounts
- Insurance coverage received from outside provider entities incomplete or policy termed
Solutions:
- Daily process validates self-pay accounts for insurance coverage
- Ability to validate Insurance coverage received from outside provider entities
- Medicaid, Managed Care and Commercial payers prioritized and cascaded
- Payer specific data alignment corrects inaccurate demographics
Results:
- 40%+ average success rate locating active coverage
- Validation process created higher clean claim rate which also resulted in higher net collection rate
- Integrated Integrex RCM API in NextGen as a process upgrade to uploading and downloading files