Large claim reviews are a vital yet complex and resource-intensive part of any organization’s payment integrity program. For a Midsize Plan, Apixio was able to reveal maximum cost savings while reducing payment timelines with the fastest speed to pay on all in-patient high-dollar pre-pay reviews.

Complex HDPR Review

This Plan needed to efficiently maximize savings balanced against limited resources for accurate reviews. Using an outsourced and outdated model, the Plan was experiencing extensive turnaround times for complex claim reviews, which was delaying payment and producing significant provider abrasion. Apixio’s solution was to quickly bridge the gap between technology and timelines by providing our software platform as a SaaS. This enabled the Plan to use in-house clinical and audit experts for greater workflow efficiency, move payment timelines far left, and significantly reduce provider abrasion. Apixio’s all-in-one platform provides unparalleled accuracy and consistency on high-dollar reviews and transparency over the entire process for controlled payment integrity outcomes.

Results

In this instance, the Plan evaluated a hospital’s itemized bill with $5.6M in total billed charges. With Apixio’s software, the Plan realized more than 28% in savings without disrupting their payment timeline and achieved an even faster speed to pay.

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