Facing intense public pressure from a recent 60 Minutes expose, this client needed to rapidly evolve its care delivery infrastructure and procedures to eliminate care gaps and provide more timely, transparent and accountable medical and mental care for non-citizen aliens held in custody across the United States.
There are almost 120,000 people waiting for transplants and that number grows by about 50,000 new patients per year. Timely review of key decisions made by transplant professionals is paramount to improving organ acceptance practices and potentially utilizing more organs. United Network for Organ Sharing (UNOS) saw an opportunity to use data analytics to correlate ...
Improving HEDIS Data Quality across Millions of Federal Employee Health Care Enrollments to Protect Reimbursement Rates
In 2015, this Federal Employee Health Payer processed millions of enrollments across 37 Blue Cross Blue Shield plans. Ineffective business partnerships, outdated technology and data integrity issues including missing Social Security numbers and Other Payer Liability challenged the client in processing enrollments and ultimately in delivering timely care to members.
In 2015, this Federal Employee Health Payer, processing over 360 million Federal employee health claims worth over $1 billion in reimbursement, was audited by the Office of Inspector General (OIG) finding many errors in the client’s Claims Adjudication processes which lead to inappropriate payments. What was needed an objective perspective, experience with large ...
Transforming Manually-Intensive, Legacy Health Claims Processing Model to an Adaptive, Real-Time Automation & Analytics Platform
This large national care provider struggled with steadily declining claims auto-adjudication rates, due to changes in Federal compliance and legislation, human error, and inefficient processes and technologies.
In a highly competitive industry, with rising cost pressures and productivity remaining flat for nearly 20 years, this global construction leader was struggling to manage costs, enhance operational efficiency and achieve Internal Rate of Return profitability targets.