An RCM firm improved claim status processes for a 1,000+ bed southeast health system by increasing successful responses by 25%, enabling touchless transactions through extended X12 data and AI-driven corrections, and refocusing labor on high-value claim denials.
Case Study
A radiology firm achieved 90% call avoidance and 7,204 successful claim status responses out of 7,500 by using AI to correct data inaccuracies, leveraging API connectivity for faster claim processing, and improving efficiency through auto-suggestions.
For 13,156 Medi-Cal accounts, we identified active coverage for 10,959 rows, corrected 2,915 names and dates of birth, resolved 617 incorrect member IDs, and uncovered Managed Care Organizations or IPAs for 8,397 rows.
An RCM firm serving hospitals and clinics achieved a 30% success rate in locating active coverage, a 2.5X ROI, and improved resource efficiency by implementing a daily insurance validation process and customizing output files for claim submissions.
A radiology firm achieved a 33% success rate in locating active coverage, a 3X return on spend, and faster revenue cycles by automating claim submissions, prioritizing payers, and streamlining Blue plan validation through weekly insurance verification.
A national wound care provider achieved a 44% success rate in locating active coverage, faster revenue cycles, lower patient outreach costs, and streamlined Blue plan validation through weekly insurance verification and payer prioritization.
A radiology firm used AI and an Anthem API to resolve 5,219 of 5,300 claims, achieving 88% call avoidance and improving denial management.
A pathology-focused RCM firm improved insurance validation, achieved a 40%+ success rate in locating active coverage, and enhanced efficiency by integrating Integrex RCM API in NextGen.