Claims Denial Management for Hospitals
Improve first pass rate with significant reduction in Claims denials. Currently Hospitals claims denial range from 15-20%. Reduce Admin cost by automation and BPO model.
- We start with historical claims to be run against HiPaaS Clinical editing database and machine learning rules to review the patterns.
- HiPaaS Clinical editing database contains data from various sources CMS(Medicare CCI, MUE, Follow-up days, Modifiers, LCD, NCD etc.), Medicaid (State’s Medicaid Payment/ clinical editing policies) and appropriate Payers payment policies.
- HiPaaS will Recommend/Provide correct coding guidelines/suggestion and flag the edits prior to sending it to Payer and it can be corrected prior to sending the Claims.
- Could be enhanced to configure Rate/Fee as per provide contract to track payment alongside.
- Could be enhanced to link with various Groupers to test the claim correctness for APC, APG, APR-DRG, MS-DRG, LTC/SNF etc.
- This is be cloud based and light weighted system with dynamic validation and regular database update.
- Get running in days
- HIPAA Cloud APIs and fully managed services
- Quickly enable Healthcare API’s (200+ API out of box)
- Quickly automate HL7, X12 integrations
- Quickly automate data reconciliation or compare healthcare data
- Quickly Digitize by exposing data over interactive dashboard
- Dashboard and Analytics capability
- Accelerators for code development
- Full Managed Services model
- Extremely cost-effective
- Lightweight to get started
- Standards based integration
- Cloud based hosting with AWS or On Premise