In a strategic transfer that may take claims administration to the subsequent stage, Experian Well being not too long ago acquired Wave HDC, a healthcare know-how firm specializing in AI-guided information seize and curation. The acquisition brings collectively the 2 corporations’ capabilities to supply healthcare organizations sooner and extra correct healthcare protection identification. With this acquisition comes Affected person Entry Curator, a brand new answer that makes use of synthetic intelligence (AI) to revolutionize the claims administration course of.
Tom Cox, President at Experian Well being, says, “With our huge clearinghouse information sources and Wave HDC’s know-how and experience in insurance coverage information seize processes, Experian Well being now gives the very best eligibility and insurance coverage identification merchandise available in the market.”
This text offers a run-down of Affected person Entry Curator and the way it helps suppliers stop declare denials in seconds.
Stop denials on the entrance finish
Managing claims successfully – or extra particularly, stopping denials – is among the largest challenges for suppliers. In a 2022 survey by Experian Well being, 72% of respondents mentioned lowering denials was their high precedence, citing causes together with payer coverage adjustments, reimbursement delays, and an increase within the variety of errors and denials.
Most points that result in denials crop up early within the income cycle, when data is missed or captured incorrectly throughout affected person registration. Because of this, it is smart to focus denial prevention methods on the entrance finish.
With a lot information to seize, guide methods are sure to stumble. Sadly, many digital instruments nonetheless require employees to test a number of payer web sites and information repositories to confirm insurance coverage eligibility and test for any billable protection that may have been missed. Experian Well being’s industry-leading claims administration merchandise are designed to simplify these processes. The integration of Wave HDC’s AI-powered information seize know-how strengthens that provide with capabilities beforehand not obtainable.
As Cox says: “Our mission is to simplify healthcare, and this transfer permits us to rapidly scale our portfolio with superior logic and AI-powered know-how to assist resolve one of many largest administrative issues suppliers face as we speak, which is declare denials.”
For Jordan Levitt, co-founder of Wave HDC, the merger is an opportunity to convey their distinctive know-how to extra healthcare organizations. “We consider this integration could have a robust influence for the healthcare {industry}, bettering monetary solvency and efficiencies for suppliers via extra correct medical billing, leading to doubtlessly extra reimbursement, sooner.”
Introducing Affected person Entry Curator: Claims administration in a single click on
Wave HDC’s know-how captures and processes affected person insurance coverage information at registration utilizing an “if-then” logic that returns a number of information factors from a single inquiry, in 30 seconds. By means of Affected person Entry Curator, registration employees can leverage this know-how to gather and confirm a lot of the knowledge they should compile an correct declare, with only a single click on. In a matter of seconds, they’ll have a complete readout of the next:
- Eligibility verification: PAC mechanically interrogates 271 responses, flagging up energetic secondary and tertiary protection data to get rid of protection gaps;
- Coordination of Advantages (COB): Integrating with eligibility verification workflow, PAC mechanically analyzes payer responses to search out hidden indicators of further insurances that could be missed by a human eye, and triggers further inquiries to these third events to find out primacy, for sooner COB processing;
- Medicare Beneficiary Identifiers (MBI): PAC makes use of AI and robotic course of automation to search out and repair affected person identifiers so nobody misses out on important assist;
- Protection discovery and monetary standing: For affected person accounts marked as self-pay or unbillable, PAC automates further protection searches, and offers insights into the affected person’s propensity to pay;
- Demographics: Lastly, however under no circumstances least, the platform can rapidly test and proper affected person contact data.
Suppliers can hear extra about shifting denials administration to the entrance finish of the income cycle with Affected person Entry Curator on a latest on-demand webinar hosted by Jordan Levitt and Jason Considine, Chief Industrial Officer at Experian Well being.
On the webinar, Levitt explains that Affected person Entry Curator achieves such speedy outcomes “as a result of the underlying code acts like a Rosetta Stone, mechanically translating the language of the person and the well being system into the phrases required by the payer.” This implies information might be transferred simply between interfaces. “The reply isn’t a number of clicks, operating one transaction at a time. With Affected person Entry Curator, you may know the whole lot in regards to the affected person to run a clear income cycle course of and propagate solely clear information downstream, all inside thirty seconds.”
Maximize {dollars}, decrease workload
Affected person Entry Curator strikes away from guide strategies and verifies eligibility and protection mechanically, rapidly and precisely. However the platform guarantees greater than effectivity; with this know-how, Wave HDC has prevented denials of over $1 billion since 2020.
At a time when income cycles are below rising stress from altering payer guidelines, labor dynamics and operational constraints, the brand new integration gives a long-awaited enhance to each reimbursement charges and productiveness.
Affected person Entry Curator is offered now – learn the way your healthcare group can get began and stop declare denials in seconds.