1. / Healthcare Revenue Management Firm Reduces Denials by 95%
Overview

With healthcare management and legislative changes across the USA, manual claims management is becoming an increasingly tedious operation, where errors and delays can lead to expensive claim denials. 

When a healthcare revenue management company faced increasing claims denials due to poor filing processes, Apexon helped them meet revenue targets with an automation solution.

Problem

Having to integrate automation into systems that dealt with multiple, disparate payer websites presented its own set of challenges. Additionally, the client needed an automated way to check claims status on their payer portal and take action on the basis of the member’s historical transactions.

Solution

Using a combination of RescueNet Billing, Payer Logic, and our proprietary automation frameworks, Apexon was able to,

  • Deliver Excel-based automation to read individual work orders
  • Deploy web automation to crawl through Payer Logic and other webpages
  • Establish desktop automation to validate the member status within RescueNet
  • Extract member history data, employ string manipulation and define business rules to identify and validate denied claims
  • Automate the denial filing process to the patient or payer in accordance with set logic
Impact

In summary, the customer’s claims filing process was rapidly automated enabling them to save costs and deploy more accurate services. 

  • Reduced denials due to lack of timely filing by 95%
  • Accurately assign payer or patient responsibility for each claim

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