the challenge
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.
What we do
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.
THE OUTCOMES WE DELIVER
Automatic Bang for your Buck
ApexonClaims delivers significant efficiencies:
reduction in the number of touches
review of claims
reduction in rework/re-routing
improvement in error identification vs. manual process
reduction in manual intervention
for single-touch claims
basis point improvement in claim accuracy
Our approach
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.
ApexonClaims in Action
Healthcare Revenue Management Firm Reduces Denials by 95%
ApexonClaims helped a healthcare firm save costs and reduce denials with an RPA-enabled claims processing system.
Healthcare Payer Saves Overpayments Worth $1.5M per Annum
ApexonClaims helped a US-based healthcare payer intelligently adjudicate claims and predict likely overpayments with 99.7% accuracy.