40-year-old multi-specialty improves patient satisfaction and claims revenue turnover using GlanceClaim™
Results
Total Claims Processed
> 1.7K per month
Average inappropriate services caught
> 2.3K per month
Average $ saved
44%
Total services analyzed
> 10K per month
Summary
A small healthcare provider situated in the eastern part of Riyadh. They serve a small population who remain loyal to their doctors. Insurance revenue represents a large part of the clinic's revenue. Unfortunately, the team responsible for claim preparation did not have the experience needed to create high-quality claims. GlanceClaim™ helped the provider reduce their rejections which allowed the provider to continue serving their population.
Problem
The clinic had a strong workforce of 17 doctors however the team was not equipped to accurately prepare over 10K claims a month which resulted in several issues with claim documentation and coding.
The clinic needed an innovative solution that could help their staff greatly reduce errors on claim forms prepared by their staff as well as ensure smooth processing of claims by the insurance company.
Solution
GlanceClaim’s actionable and easy-to-use claim checker and coding support tools were introduced to the medical billing and clinical team. With the help of GlanceClaim™ tools, the account was able to automate several tasks in their workflow and was able to check their claims for
Medical policy compliance
NPHIES data incompatibility
Contractual errors
Coding standards compliance
Medical necessity, indication, and PBM compliance.
Compliance with the regulatory policies.
Additionally, GlanceClaim™ systems supported the center’s executive team with deep analytical reports for better understanding, root analysis, and decision-making support.
Results
Using GlanceClaim™, the billing staff was able to resolve over 2.3K claim errors as well as improve the quality of documentation as well as management of claims. They could also 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 44%
Using GlanceClaim™, the medical center was able to
Reduce their claim rejection/denial rates
Reduce their preauthorization rejections
Increase the utilization of their medical services
Improve their medical documentation quality
Improve claim submission speed
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.
