Healthcare Payer Saves Overpayments Worth $1.5M per Annum

Customers expect almost-instantaneous resolution to claims. Manual claims processing, while maintaining optimum levels of accuracy, creates profitability pressures for payers, leading to unforeseen delays, higher litigations, overpayments, and unsatisfied customers.
For this customer, manually auditing claims failed to stem revenue leakage and slowed down resolution times. They were looking to automate and streamline claims processes to optimize the number of human touchpoints and make the process faster and more accurate.

Manually auditing claims to check for overpayments was leading to:

• Significant revenue leakage due to high cost of auditing
• Failure to preempt overpayments, leading to post-claim litigations
• Backlog pile-up due to slow claims processing

Apexon brought onboard ApexClaims, a proprietary advanced analytics platform embedded with classification and anomaly detection models, to:

• Integrate data from audit, call centers, recoveries, grievance and redressal, etc., for a 360° view of the claim 
• Intelligently predict financially-erroneous claims and provide supporting documentation for overpayment
• Automate sub-processes and optimize the adjudication process for human intervention
• Integrate provider data management and membership risk management