Streamlining Healthcare Claim Denials for Revenue Recovery
Managing insurance claim denials is a necessary yet often cumbersome process for many healthcare organizations. In order to overturn denied claims, providers can process thousands of insurance claims a day and must accurately match each patient and case. From there, they must consult with a physician advisor on each denied claim to overturn them. This multilayer process often relies on manual workflows that can result in inaccurate data, missed claims, and wasted hours. So, when one of the largest healthcare providers in the U.S. sought to improve their denial notification process and gain operational efficiency, they realized that a custom web application could be their answer. They partnered with UDig to build the solution and modernize the way they work.
STRATEGIC SNAPSHOT
Challenge
Processing thousands of denied insurance claims per day through a manually intensive process that created data errors, inefficiencies, and lost revenue.
Strategy
Design and develop a web application to standardize and streamline the denial overturn process.
Outcome
A robust Denial Notification Authorization (DNA) system that significantly increases the healthcare provider’s overturned denials and revenue.
Challenge: 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:
- Was not scalable, limiting the number of denials they were capable of overturning
- 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.
Strategy: 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.
Outcome: Robust Denial Notification Authorization (DNA) System
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 helped to reduce errors in the peer-to-peer routing process and enabled staff to focus on higher value activities. Further, the DNA system can quickly and easily process thousands of claims per day while increasing their Adjusted All Days Authorized percentage. By increasing volume, our client is now generating more revenue than before — and is better positioned to meet future business demands.
How We Did It
Tech Stack
- C#
- Javascript/React
- SQL Server
- Typescript
