The client was a dental FQHC in California who wanted a secure, HIPAA compliant system to process claims. The organization was a healthcare claim management company using a conventional pen and paper-based system to carry out the claims processing, which was slow, inefficient, and prone to errors. The client needed the solution to be usable across doctors, nurses, as well as payers to manage dental patients. The solution had to be custom developed according to client’s specifications.
Manual Claims Management
Higher Claim Denials
Greater Unpaid Bills
This is one of the focal points of the solution that the client needed. OSP developed an automated system to handle the workflows surrounding the processing of claims. The conventional method was slow, prone to mistakes, and unproductive. Automation greatly minimized the human element from the procedures, thereby minimizing errors, improving the speed, and finally, the revenues.
Medical coding forms one of the cornerstones of the entire healthcare industry. Every clinical visit is coded and the claims are filled out. This is where most of the errors occur, costing the provider precious revenue from payers. OSP’s solution automates the coding process and also ensures that the codes used are all updated.
When it comes to managing medical claims, it is necessary to know the pattern of denials, rejections, and approval of claims. OSP’s solution also includes a feature to analyse the claims to help the client harness useful insights. This enables the client to determine the cause of rejections, denials, and know the patterns regarding payers. It helps in making informed organizational decisions.
The result of automating coding and claims processing workflows is a drastically lower rate of denials and rejections. As a result, the organization experienced a marked reduction in the number of unpaid bills. Needless to say, this improved its revenue cycles, while also reducing overhead because of automation. It’s a win-win for all stakeholders involved
OSP is well aware of the rules stipulated by the Health Insurance Portability and Accountability Act (HIPAA). The entire solution that we developed for our client in California is HIPAA compliant and promises reliable measures to protect the privacy and integrity of medical data. OSP has undertaken thorough testing to ensure compliance.
There are various reasons for claims to be denied or rejected by payers. This is perhaps the biggest reason for providers not getting paid. OSP’s solution leverages the latest technology to automate the claims lifecycle to ensure that they are all proper, thereby reducing the chances of missed reimbursements. Moreover, the client didn’t have to hire any additional staff for the claims management. Timely reimbursements and lower overhead mean higher revenues.
Return on Investment
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