20+ doctor medical center prevents revenue leakage and increases coding accuracy using GlanceClaim™
Results
Total Claims Processed
> 40K per month
Average inappropriate services caught
> 52K per month
Average $ saved
9%
Total services analyzed
> 185.8K per month
Summary
Despite being situated near a few competitors, our client remains a trusted destination for patients. They have more than 20 doctors serving in many specialties. The high operational load and the variety of specialties put tremendous pressure on the billing team, who were not able to achieve a healthy reimbursability rate with health insurance companies.
The client needed to ensure an integral medical coding and frictionless claim workflow. Introducing automated claim checks enabled the billing team to catch coding errors responsible for revenue leakage.
Problem
This client is facing concerning claim rejection rates due to medical coding errors for over 185K services being submitted for reimbursement per month. With the added pressure of a narrow time window for claims submission, the quality of claim auditing suffered, resulting in a high rejection rate of up to 18%.
Concerned with the loss of revenue resulting from the claim rejections, the clinic needed an innovative solution that would help reduce rejection rates and increase their claim revenue and approval rates
Solution
GlanceClaim’s actionable and easy-to-use coding support tools and claim scrubber were introduced to the team and were integrated into the clinic’s claim preparation workflow. With the help of GlanceClaim™, the clinic was able to automate several tasks in their workflow, significantly reducing part of their workload. They were also able to check their claims for
Policy compliance
Data errors
NPHIES data requirements
Insurance contract obligations
Technical coding standards
Medical necessity, indication, PBM compliance, and service safety
Relevance of ICD-10 coding
Compliance with CHI policies
Additionally, GlanceClaim™ systems provided the clinic’s executive team with claim analytics which helped them better understand their claim rejection trends, coding & documentation inconsistencies, claim performance metrics, reimbursement rates, and financial data while receiving daily updates as well. GlanceClaim™ also provided a management tool that allowed the operations lead to assign claims to specific doctors in the team for documentation and processing.
Results
Introducing automated claim checks enabled the billing team to catch coding errors responsible for revenue leakage. Using GlanceClaim™ for just 2 – 3 months, the clinic could perform an in-depth analysis and evaluate multiple operational and business areas, including their technical and operations infrastructure. GlanceClaim™’s multi-stakeholder support enabled the clinic to lower its claim rejection rates significantly and improve reimbursement rates by 50%
What is GlanceClaim™?
GlanceClaim™ is an advanced medical claim auditing and documentation/decision support system designed to improve claim integrity and quality, and workflow for healthcare providers. As Saudi Arabia’s first in-house medical claim expert system that supports digital ICD-10 coding and documentation, and clinical decision-making, GlanceClaim™ is uniquely positioned to solve various occurrences of technical and medical documentation errors on claims.
Facing challenges with insurance rejections and payouts? We would love to help!
Enables the provider’s revenue cycle team to analyze and evaluate claims against an extensive rule engine to ensure high claims integrity.
System Outcomes
Check for policy compliance.
Check for data errors.
Check for compliance with the NPHIES platform’s data requirements.
Check for contractual agreements with insurance companies.
Check for medical coding quality against the Australian Coding Standards (ACS).
Check for medical necessity, indication, PBM compliance, and service safety.
GlanceClaim™ Coder | Document | MedServices
Physicians are able to correct claims in accordance with the Saudi CHI unified medical policy, insurance companies' criteria, and medical necessity using GlanceClaim™ Coder.
System Outcomes
Physician-friendly ICD10 AM code finder.
Utilizes auto-suggested clinical documentation.
Follows justified medical services per the ICD-10 AM code.
Business Value
Productivity, fast documentation, and accurate coding.
Compliant with CHI policies.
Compliant with SCFHS and MOH practice guidelines.
Ensure payer-friendly decisions.
Reduce operational costs.
GlanceClaim™ Admin
Admin dashboard visualizes claims and financial performance to support better decisions.
