About the Client
Large Hospital System
Problem Overview
Healthcare facilities are confluently experiencing slow-pay practices by commercial payers, despite contractual provisions to the contrary. This translates into an ever-growing A/R, payroll crises, cash-flow uncertainty, capital project delays, and C-Suite fiscal preoccupations, constraining quality improvement and strategic planning initiatives.
TeraCrunch AI Claim Denial Management Tool
TeraCrunch has developed an innovative AI tool that accurately flags (all with an est. 95% certainty) claims with high risk of denial with the reason codes. The tool takes 835/837 files and run the predictions in real-time. Building this intelligence into the workflow prior to claim submission was a huge success for the client's RCM team. This tool also comes with a descriptive dashboard for claims management that provides actionable insights to improve processes and teams focus on high value areas. Our solutions are developed by top PhD data scientist and experienced physicians.
Impacting Healthcare with TeraCrunch Solutions
Utilizing TeraCrunch's tool, this healthcare organization decreased claims denials and appeals cost on the backend. TeraCrunch's Interactive Descriptive Dashboard visualizes data in a prioritized, actionable format that helped the Revenue Cycle leadership with key insights to optimize processes for cost savings.
Key Benefits
Decreased denials 3-5% Focused staff time on codes that will not get paid fully or at all.
Provided the C-Suite with an accurate picture of anticipated cash flow and uncovered process improvement opportunities
With 95% accuracy in predicting denials, it decreased staff's back office time by 35%
