Automate claim status and accelerate cash.
Stop spending hours trying to decipher why claims have been denied, or wasting time chasing claims that have already been approved for payment. ClaimStatusPlus™ replaces endless questions with answers, often within a few days of submission and automatically routes claims needing remediation to specialists so you can double employee productivity.
Lower the high cost of getting paid.
Intentionally or not, the current healthcare landscape seems designed to reduce the revenue providers earn per patient, no matter how high in quality the care or the cost to deliver it. This is evident in the reimbursement process where payers often take up to 60 days just to notify providers whether a claim has been approved or requires more information. This delay not only creates chronic revenue shortages, it restricts your ability to budget and plan for future investments in services. Compounding the delay, claim remittances commonly take up to 40 days or longer to arrive, leaving you with few options other than to passively wait or pursue costly fixes such as staffing up or hiring third parties to follow-up with payers via decades-old electronic data interchange (EDI) technology.
The key to speeding up claim payments is knowing soon after submission which claims are going to get denied, either partially or fully, with enough detail for the right staff to begin remediation efforts. Claim status automation solves these problems through a three-pronged approach: exponentially faster notification of claim status, detailed explanations of the problems with each denied claim, and workflow triggers that guide staff in remediating partially and fully denied claims.
Four antiquated approaches
The long wait
You know that the longer an account ages, the more difficult it is to collect. Insight into status on claims is needed within 30 days to keep it active and likely to be paid in full. Waiting for the payer to give this insight is not a viable option. Even if the payer were to send notice of denials within 30 days, very few offer clear reasons for denial.
The chief problem with assigning additional staff to continuously call and check claim status with payers is that you have no way of knowing if staff are pursuing claims that have already been approved. It’s not uncommon for employees to spend more than half their time following up on approved claims; a poor use of back office staff who should be focused on remediating only problem accounts.
Throwing additional manpower at the problem may somewhat lessen its impact, but will never solve it. Moreover, you’re now paying a third-party to perform a blanket chase of all claims outstanding rather than focusing only on the exceptions. Outsourcing might make more sense if the vendor had better access to payer data that would streamline their process.
EDI 277 Transactions
The creation of electronic exchanges of information was intended to vastly speed up communication about claim status, but the 277 response typically does not explain the reason for denial, only whether the claim has been denied or approved. This means your business office staff have had to become experts at deciphering payer response, or are routing these claims to costly senior resources for remediation.
Remove up to 80% of manual follow-up.
You’re likely paying for resources unnecessarily, just to get paid what you’re owed. Believe it or not, business office staff often spend more time following up on claims that are already going to be paid than on remediating those that are going to be or have been denied. Imagine the savings if that wasted time could be eliminated by identifying approved claims earlier and removing them from work queues.
ClaimStatusPlus™ is an exception-based processing automation solution that eliminates up to 90% of claims from manual follow-up by quickly identifying those that have been approved, retrieving complete claim status data from payer websites and EDI. Our automated technology uses workflow triggers to route those claims needing remediation to experienced staff with reasons for denial.
Our technology delivers and normalizes the most complete and current answers on claims status. Automated intelligence closes claims set to be paid and prioritizes problem accounts, noting payer-specific codes to make the account immediately actionable.
We can scale to almost your entire A/R inventory, making this particularly compelling for large health systems, and we easily integrate with most major health information systems, including Epic, Cerner, McKesson, Meditech, Allscripts and Artiva.
We’re the first and only HFMA Peer Reviewed claim status automation software, and we have a portfolio of reference customers. With credentialed access to 100+ payer portals in dozens of states, we’ve got experience obtaining and interpreting claims data.
Recondo’s ClaimStatusPlus even flagged when a payer’s turnaround time changed. We got the payment period adjusted, amounting to a $5 million cash flow improvement. The results have been wonderful and we expect them to keep coming.
We found Recondo to be aligned with our guiding principles of integrity and accountability. Recondo’s continued support and partnership have established the company as an extension of the Queen’s Medical Center’s business office.
My staff were living in backlogs of work, and unpaid accounts could remain unresolved up to 82 days or even 120 days in some facilities. Because of this lack of timely filing, we were also doing considerable write-offs. Recondo’s solution promised to alleviate the burden on my staff. This was important. We do get some turnover, which is expensive.
The cash flow improvements and cost savings have been very apparent. It’s much less expensive to automate claim status verification with Recondo than add staff.