Plugging Revenue Leaks in Claims Processing

Medical billing mistakes can result in significant dollar losses for healthcare payers. The ‘pay and chase’ strategy is neither effective nor efficient. Robust revenue cycle management begins with reducing operational and medical expenses, with a special focus on identifying revenue leaks and plugging them immediately. Payers need a modern, digital solution that can not only identify payment errors, but also predict them using existing data at their disposal. These solutions require advanced analytics capabilities that can increase their precision over time and improve overpayment avoidance year after year.

ApexonClaims

ApexonClaims combines advanced analytics technology in the cloud, proven processes for precise claim assessment, and a team of experts adept at building tailor-made claims analysis solutions for payers. As a result, payers are able to minimize overpayments and reduce avoidable manual touches during the adjudication process.

Automatic Bang for your Buck

ApexonClaims delivers significant efficiencies:

• **20% **reduction in the number of touches
• **100% **review of claims
• **10% **reduction in rework/re-routing
• **12x **improvement in error identification vs. manual process
• **30% **reduction in manual intervention for single-touch claims
• **3-5 **basis point improvement in claim accuracy

Advanced Analytics and Automation

ApexonClaims uses classification and anomaly detection models to accurately predict financial leakages.

Key capabilities include:

Claims Administration Use AI-backed insights to highlight improvement breakthrough opportunities in pre- and post-payment processes. Manual touch reduction gets it right the first time, while proven claims processing and audit build better compliance. Member Management Drive member management systems easily and efficiently with automation. Push for higher star ratings, increase member satisfaction, and maximize enrollment. Provider Network Management Use automation to manage impaneled provider networks at scale with credentialing services, contracting, and improved process tracking and reporting. Risk Coding Leverage machine learning models to identify risks and adjust according to Hierarchical Condition Category (HCC), which assesses expected medical costs based on a proven scoring system.