High-aged claims are usually difficult to resolve, as they would have undergone multiple iterations (touches) and denied due to various reasons. Resolution of these claims require deep domain knowledge and a methodical/systematic problem-solving approach. This means a considerable investment of time by highly experienced/skilled resources.

A team of highly skilled denials/AR experts were chosen who were proficient in resolving highly aged claims. The claims were stratified / grouped into priority based action codes, payer groups and denial reason to enable root cause analysis in a systematic manner.

Sagility provided identification of provider credentialing issues like termination of contract or delay in the start dates and timely fixing. Several payer level issues were identified and escalated with client stakeholders for immediate solutions.

Follow-up rigor was improved significantly by crushing timelines between follow ups. This helped us with faster collection of required information to identify and address the root causes of denials quickly

The in-scope claims for this solution were excluded from the manual intervention and are handled by bots completely. The bot will compare the original and corrected claim, identify the changes if any and incorporate those and complete the process end to end.

This process included correctly triaging claims to departments like coding, nurse auditors, payment posting or correction, clinical appeals, and responsible payer group liaison.

A weekly view was presented to the client for inflow of new inventory/ claims and outflow of resolved claims or claims directed to right department and visibility of outstanding AR and its collectability indicating if it’s low, high, or none.