Medical group to increase claim revenue and improve documentation quality using GlanceClaim™
Results
Total Claims Processed
> 18K per month
Average under justified services
28K per month
Average $ saved
24-25%
Total services analyzed
69.8K per month
Summary
Part of a 3 medical centers group and established since 1992, our client serves Riyadh’s main areas and is recognized as a high-quality healthcare provider. They serve more than 16 specialties. This client aims to reduce claim rejection and efficient internal auditing processes.
GlanceClaim™ supported this group to reduce rejections and improve pre-approval requests.
Problem
With around 70 thousand claims being submitted per month and a rejection rate of 15% - 35%, manual auditing for every claim was impossible. Bearing the claims’ high denial rates while updating technology infrastructure to be NPHIES complaints is a strenuous task. The client wanted a solution to minimize its manual workload while improving its claim approval rates.
Concerned with the potential complexity and business disruption, the client needed an innovative solution that would reduce manual intervention along with the option to integrate easily with daily operations and workflow.
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™ for just 3 months, the clinic could perform an in-depth analysis and evaluate multiple operational and business areas, including their technical and operational infrastructure. GlanceClaim™’s multi-stakeholder support enabled the clinic to lower its claim rejections and improve reimbursement rates by 24% - 25%
GlanceClaim™ enabled a positive cultural transformation within the medical team and the billing team toward more interaction and communication.
Reduce claim rejection/denial rates
Reduce pre-authorization rejections rates
Increase the utilization of 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.
