Client’s Challenge
Inaccurate Claims Payouts
A Fortune 500 Major Healthcare Payor needed to accurately pay claims as secondary for Medicare Advantage and Medicaid when a member also had commercial coverage.
Case Studies
Claims Automation Creates Millions in Savings
Automated Claims Calculations and Refined Processes Lead to $3.5 Million Cost Savings
Our Solution
Automation of Calculation Methods
InfoWorks implemented various automated calculation methods for accurate processing of payment amounts, and a series of claim edits to prevent erroneous payments and denials.
Value Realized
Savings of Approximately $3.5M
Our client realized a decreased need for manual intervention throughout the claim development process. We exceeded the project goal of $1.5 million in COB savings, with our client’s actual savings equaling approximately $3.5 million for COB.
Project Details
Our client needed to accurately pay claims as secondary insurance for Medicare Advantage and Medicaid when a member also had commercial coverage. This effort involved the implementation of various automated claims processing methods for accurate payment calculations. Additionally, it included a series of claim edits to prevent erroneous payments and denials.
After completing a series of edits in our client’s database system, InfoWorks was able to completely automate their claims calculation process. Plus, we sorted claims to find ones filed incorrectly. This automation eliminated the time-consuming manual processes previously required to process claims.
Following the project’s conclusion, with the help of InfoWorks, the Coordination of Benefits (COB) savings amount was on track to double the initial annual savings estimate.
Our solution decreased the need for manual intervention throughout the claim development process and surpassed the project goal of $1.5 million in COB savings. The total savings reached around $3.5 million for COB.
