OUR APPROACH
THE IDEA
Overcome a Labor-Intensive Claims-Review Process
Our client was managing thousands of denied insurance claims a day. These claims were coming from many different insurance companies in various formats, such as faxed sheets and handwritten notes. Their goal was to overturn as many claims as possible in order to recoup lost revenue. However, their existing process wasn’t enabling them to work efficiently to overturn those denials. They used a manual process for storing and sharing data that required many hours of employees’ time.
The organization’s existing process:
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Was not scalable, limiting the number of denials they were capable of overturning
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Enabled human error when manually managing data, complicating their ability to work efficiently
This cumbersome process resulted in the company falling behind in their ability to process the volume of denied claims they received each day. As a result, they were leaving millions of dollars on the table.
THE PROCESS
Design and Develop a Scalable, Intuitive Application
The solution had to be scalable and responsive in order to support our client's high volume of denied claims. UDig partnered with the healthcare organization to understand their existing processes, current gaps, and future goals. The objective was to determine the solution’s strategy and design that would meet both their technical and business requirements. UDig provided a development team to build the solution in an iterative delivery model. Doing so ensured our client was providing input and feedback throughout the development process.
The Impact
Today, our client has a scalable solution that automates the process of segmenting, prioritizing, and routing denial cases to an appropriate external/internal resource for peer-to-peer reviews. What once was a manually intensive process is now a robust software application that has reduced errors in the peer-to-peer routing process and enabled staff to focus on higher value activities. The DNA system processes 4,000 claims per day with efficiency, increasing their Adjusted All Days Authorized percentage. With even a modest improvement in overturning denied claims, our client is on track to recover $10+ million annually, solidifying their ability to meet future business demands while generating significant revenue.
