Tag: claim denials

Automated claims processing could solve one of the biggest challenges currently facing healthcare providers: maximizing reimbursements by minimizing denied claims. Denials have been steadily increasing over the last few years. An MGMA Stat survey found that nearly seven in ten providers witnessed a jump in denials during 2021, although the trend took hold even before COVID-19 hit. If providers rely on outdated systems and tools to process the growing volume of claims, it's inevitable that denial rates will continue to climb. It's not surprising then that a new Experian Health survey revealed almost 3 in 4 providers stated that reducing claim denials takes precedence over other priorities. Getting claims right the first time is no easy task. Traditionally, the claims management process has been labor and time intensive. Claims teams spend hundreds of hours gathering documentation, preparing claims for submission, engaging with medical clearinghouses, and then monitoring claims adjudication while they await the payer's verdict. Should a claim be denied, more staff hours may be required to rework it for a second attempt at reimbursement. Even if administrative budgets and staffing numbers increased in line with demand, inefficient manual systems can no longer bear the burden of data to be managed. With more providers heading into the danger zone of claim denials, automated claims processing tools are growing in popularity. These enable more efficient claims management, boosting productivity, easing pressure on staff, and above all, minimizing denials. Experian Health's survey found that 78% of providers are open to replacing current technologies if they are presented with compelling ROI projections, reflecting the urgency of the situation. What is automated claims processing? Automating claims involves the use of digital technology, software, machine learning and advanced analytics to optimize healthcare claims management. This can include: pre-filling data into digital forms to avoid data input errors using intelligent document processing to pull unstructured information into a single, usable format comparing data from multiple sources and flagging inconsistencies providing real-time insights and status updates allowing multiple parties to work from interoperable data Tools such as robotic process automation (RPA) can be used to replace manual activities, using data, logic and business rules to make decisions within certain parameters. This eases pressure on busy staff and improves efficiency, for example, when prioritizing claims to be reworked. Imagine how much faster a software program can synthesize hundreds of current and historical data points, compared to a human trying to do the same job. There are opportunities to automate just about every stage of the claim lifecycle, from the patient's first interaction with their provider to reimbursement. For example, automation can be used to: Streamline patient onboarding and automate identity checks to avoid errors in patient information Verify insurance eligibility and run continuous coverage checks to see if the patient's status has changed Maintain a complete electronic health record that follows the patient throughout their healthcare journey, so claims contain correct information Track payer policy changes and apply custom edits so that coding information is correct Scrub claims to find and fix any errors before they are submitted Submit claims to payers and monitor the claims adjudication process Optimize the denials management workflow and prioritize denied claims for resubmission Verify reimbursements and initiate patient billing processes. Virtually any repetitive, process-driven, or paper-based task from claim creation to claim reimbursement is an opportunity for automation. As technology advances, so do the opportunities to streamline operations, reduce time to reimbursement, optimize decision-making, reduce costs and improve the patient experience. Here are the 5 benefits of automated claims processing: 1. Automated claims processing streamlines operations Automation's number one benefit is allowing providers to move away from inefficient and error-prone manual processes. Staff no longer need to sift through disparate and complex coding lists, medical records and payer edits looking for the correct information to attach to a claim. Together with electronic records management, automation allows for standardized workflows, so the entire claims cycle is more consistent, and decisions are based on real-time accurate data. It helps to eliminate time spent searching for missing information, reformatting data to meet payer requirements, and trying to figure out which claims are worth reworking. Multiple digital tools are available to optimize different tasks within the claims processing workflow. But for maximum efficiency, providers should look for solutions that work together within an integrated system. Using a single vendor makes it easier to manage data consistently and simplifies system-to-system interactions. A comprehensive claims management solution also creates a smoother user experience, for example, by allowing staff to check real-time insights within one dashboard, using one log-in. Experian Health's suite of healthcare claims management solutions connects each step in the claims workflow to speed up claims processing. For example, ClaimSource manages the entire claim cycle in a single, scalable online application that serves individual hospitals and physician practices through to large multi-facility health systems. It creates custom work queues and integrates electronic remittance data directly, to allow staff to prioritize high-impact claims and speed up reimbursement. 2. It saves staff time and resources Outdated and clumsy processes can contribute to staff burnout, poor performance and difficulties attracting and retaining top talent, even more so as patient volumes return to pre-pandemic levels. By removing many time-wasting manual tasks, automated claims processing allows staff to use their time more productively. It's particularly important amidst ongoing staffing shortages, which put additional strain on existing staff. Some of the most time-consuming manual activities occur in the prior authorization workflow. Prior authorizations are also a common cause of claim denials. Because payer requirements around prior authorizations change frequently, staff must painstakingly check each payer's website before submitting authorization requests to ensure that the necessary documentation is in place. Once submitted, they must log in to different payer portals to track progress. According to the American Medical Association, some physician practices spend more than two full days processing prior authorizations each week. But with automated prior authorizations, staff can prevent delays and denials. Online prior authorizations automate inquiries and submissions without the need for user intervention, instead drawing on payer data that are already updated and stored in the system. It auto-fills the necessary information and flags where manual intervention is required. It can initiate more authorizations in less time, and guide staff to the highest-priority tasks using dynamic, exception-based work queues. By reducing the error rate, automation also facilitates faster claims processing, which means payments can be processed and issued more quickly. 3. Automation generates more accurate and actionable insights Automation doesn't just save time; it also gives staff greater clarity and control over the claims process. Automated digital solutions facilitate more reliable data management to reduce errors, and generate real-time insights based on accurate information. A large proportion of claims are denied because patient information doesn't match the payer's records. This can be easily avoided using robust electronic medical records that hold data in standardized formats and automatically populate forms with the correct information. Electronic data management also gives staff richer and more reliable insights, by pulling together all the information they need into a single, accessible interface. Using an automated tracker such as Denial Workflow Manager makes it easy for staff to monitor claims, denials and remittances in one place. Not only does it track denials, holds, suspends, zero pays and appeals, but it also provides detailed analysis to help root out the causes of denials, so they can be avoided in the future. Staff can immediately see which claims need attention and resolve them much more quickly, as opposed to using manual processes. Enhanced Claim Status complements Denial Workflow Manager by automatically generating work lists for staff, complete with actionable data to help them check off the tasks quickly and accurately. The software sends automated status requests based on each payer's claims adjudication timeline, to see if claims are pending, denied, returned-to-provider or zero-pay transactions. This takes place before the Electronic Remittance Advice and Explanation of Benefits are processed, so staff can respond quickly and avoid unnecessary denials or delays. 4. Faster claims processing equals faster payment According to the Council for Affordable Quality Healthcare (CAQH), the time saved by switching from manual to electronic claims processing could save the medical industry up to $1.7 billion each year. The increase in accuracy leads to more first-time pass-through rates and optimized decision-making around which claims to rework. While automation requires some upfront investment, the output tips the balance in favor of faster, higher reimbursements. Experian Health's Claim Scrubber solution is one example of how automated claims processing can reduce undercharges and denials, optimize staff time and improve cash flow. This program reviews each pre-billed claim, line-by-line, to check that coding details are accurate. It then applies general and payer-specific edits and verifies that the claim is free of errors before it's submitted to the payer or clearinghouse. As a result, more claims are correct – and therefore paid – the first time, and staff can spend less time chasing old accounts receivable. Case study: Read how Summit Medical Group Oregon – Bend Memorial Clinic reduced A/R days and volume by 15%, and achieved a 92% clean claims rate with Claim Scrubber and Enhanced Claim Status. 5. Automation can transform the patient experience Getting claims right the first time starts at the beginning of the patient journey. A digital patient access experience is more convenient and satisfying for patients and helps prevent errors that can lead to denied claims later. Patient contact information can be automatically pre-filled so the patient can check for errors. If a patient adds new data when they're scheduling or registering for care, that information can be automatically checked against the data already on file, and flagged if there are inconsistencies. Further along, the efficiencies afforded by claim process automation mean patients don't have to wait so long for confirmation that their medical expenses have been handled. Or, if they have an out-of-pocket amount to pay, they'll get clarity about their financial responsibility much sooner. Patient portals are a great tool for helping patients track claims when and where it suits them, rather than having to wait to speak to a call center agent. And by making the claims process more efficient, automation also releases staff from time-consuming repetitive administrative tasks so they're free to support patients with more complex queries. Automation can elevate the customer experience with personalized communications and simplified transactions, from patient access to patient payments. Transitioning to automated claims management As the volume and complexity of claims to be processed increases, providers need to find ways to manage the workload, alleviate pressure on staff and prevent unnecessary revenue leakage. Working with a trusted vendor can ease the transition to automation and maximize potential cost savings. Experian Health provides industry-leading software solutions to improve healthcare claims and denials management so that more claims are clean the first time. In fact, Experian Health was voted as the top claims vendor for hospitals in the 2022 Black Book vendor survey, for the second year in a row. Find out more about how Experian Health's suite of healthcare claims management products can help providers reduce denials, rebilling and drive up reimbursements with automated, clean and data-driven claims processing.

The payer policy rollercoaster has taken a few twists and turns recently, leaving healthcare organizations out of the loop if they try to keep pace with payer requirements using manual systems alone. Keeping track of changing payer requirements has long been a major challenge for providers, but several shifts in the reimbursement landscape have prompted payers to implement updates at rates providers may struggle to match. More flexible policies permitted during the pandemic are being rolled back, altered employment patterns are influencing insurance plan administration, and new clinical delivery models (such as telehealth) are necessitating different coding structures. Healthcare providers that fail to keep up with these changes could end up wasting many hours and resources to rework claims. Instead, they should consider using automated payer alerts to ease the administrative burden, keep a lid on denial rates and protect profits. Automated payer alerts give providers the power of knowledge For many providers, staying on top of payer requirements involves recurring calendar reminders to check payer websites, subscribing to payer newsletters or social media accounts, or poring over industry media coverage for a hint at possible changes to come. If these checks were automated, providers could save hours of valuable staff time, and feel confident that no vital details are missed. With automated Payer Alerts, providers get instant access to the payer policy and procedure changes they’re too busy to catch. It’s a simple and convenient way to monitor modifications so claims can be submitted correctly the first time. This means staff can spend less time researching changes to procedures. Through an online portal and daily email digest, providers get timely alerts about payer changes posted on more than 120,000 different web pages. Every notification is the result of extensive behind-the-scenes work by Experian Health’s proprietary software. The program generates alerts with a detailed summary of changes, a link to the affected policy and a breakdown of changes by healthcare specialty. This allows providers to prioritize those that are most relevant to their organization. Client success story: Payer Alerts pay big dividends Being in the loop about what’s covered and what’s not puts providers in a better position to protect revenue by enabling more efficient allocation of resources, minimizing claim denials and avoiding missed revenue opportunities. New York-based University Physicians Network (UPN) implemented Payer Alerts to help physicians avoid denied claims. The CEO said, “Payers are increasing their edits, but if you know about them ahead of time and can make the required adjustments, you can avoid both denials and time-consuming appeals. With Experian Health, we now have an automated, straightforward process that helps us minimize unnecessary denials and take a proactive approach.” One UPN group recovered $42,000 as a result of a Payer Alert on a single policy change. Amplify results with the right healthcare payer solutions Payer Alerts helps healthcare organizations streamline their workflow and maximize revenue through more than just its immediate features. Its compatibility with other automated healthcare payer solutions can build the perfect defense against payer reimbursement challenges. For example, combining Payer Alerts with Contract Manager and Contract Analysis helps hospitals manage multiple payer contracts and checks that the correct amount has been reimbursed. Contract Manager allows providers to monitor payer performance and arms them with the data to negotiate more favorable contracts. It generates reports that support better communication with payers. This results in fewer phone calls to resolve issues and reduces the likelihood of misunderstandings over patient insurance status or whether a claim was received. Similarly, Claim Scrubber works alongside Payer Alerts to review every claim and verify that it’s coded correctly before being sent to the payer, to reduce the risk of denials. Claim Scrubber also now includes billing modifiers designed to support compliance with the Appropriate Use Criteria program. Using Payer Alerts to keep pace with regulatory changes Looking ahead, providers must continue to pay attention to legislative changes that affect payer strategies. Implementation of the No Surprises Act and related legislation should lead to greater transparency and more effective data sharing within the healthcare community. However, it also puts pressure on payer-provider relationships. Payer rules may continue to change, which means that payers may interpret these rules differently. Experian Health’s regulatory solutions can help providers stay on top of these changes and avoid penalties. Ultimately, providers can’t respond to changing payer policies if they don’t know those changes have been made. While change is inevitable, losing valuable time and revenue to inefficient manual processes is not. By investing in automated healthcare payer solutions, providers can adapt to change and stay ahead of the game. Find out more about how Experian Health’s Payer Alerts can help healthcare organizations capture the necessary information to make timely and strategic decisions to protect profits.

Navigating an increasingly complex reimbursement landscape remains challenging for today’s healthcare providers, with too many claims still underpaid, delayed or outright denied. In fact, nearly 70% of providers said the problem of denied claims had worsened during 2021. Naturally, relationships with payers suffer, adding friction to the process. To this end, revenue cycle leaders are relying on claims management software to create more visibility into complex contract and claims management processes. These data tools can resolve or prevent the snags that often interfere with claims processing and billing workflows, which allow providers to streamline claims processing, improve communication with payers and accelerate a patient’s payment lifecycle. The path through that bureaucratic jungle requires high-quality information at every step. Accurate patient data, error-free clinical documentation, up-to-the-minute payer policy updates, and verified billing software and claims edits are all essential to help reduce denials and ensure faster-flowing payments.  With so many options on the market, providers should look for healthcare claims management software that provides support in four critical areas. 1. Simplified contract management Managing and understanding the tangled web of payer contracts, insurance rules and regulations can be time-consuming and overly complex. Keeping up with ever-changing reimbursement methodologies is resource-intensive for teams that are already suffering from staffing shortages. A system like Contract Manager and Contract Analysis can ease the pressure by streamlining workflows and showing revenue cycle management teams how payers are performing against agreed-upon terms. Contract Analysis seamlessly integrates with Contract Manager to provide all the data needed to make informed decisions about whether potential contract terms are in line with business goals – before any commitments are made. 2. Claims management software should help with error-free claims submissions In a perfect world, all claims would be completely accurate every time. But errors inevitably do creep in, leading to confusion, delays, and non-payments. Healthcare providers lose massive sums of money each year due to inaccurate claim submissions, denials, corrections, and rebilling. A good claims management strategy ensures that claims are error-free before they’re submitted. Claim Scrubber is an automated solution that reviews every line of each pre-claim and verifies that it is coded with the correct information before being sent to your claim’s clearinghouse. The result? Fewer undercharges and denials, optimized staff time and better cash flow. 3. Visibility of submitted claims With multiple steps, stakeholders, and milestones, keeping track of what’s happening with a claim can be cumbersome. Regardless of the workplace setting – individual hospital, large physician practice or a multi-facility Centralized Business Office – revenue cycle leaders need streamlined workflows, custom provider and payer edits, and superb customer support. ClaimSource is a solution that ensures all hospital and physician claims are clean before submission to government or commercial payers and creates custom workflows for easy prioritization and organization. With ClaimSource, providers can manage the entire claims cycle, from eligibility validation, claims editing, claims submission to the payers, claim submission reconciliation, remit retrieval, and reporting, in a single online application. 4. Claims management software should help prevent claims denials Denial rates vary widely between issuers. One 2020 study of HealthCare.gov issuers found that 1% to 57% of in-network claims were denied, while over 70% of major medical issuers had a claims denial rate of over 10%. Many reported denying one-third or more of all in-network claims. A tool such as Enhanced Claim Status makes it easy to respond early and accurately to denied, zero-pay, pending or returned-to-provider transactions before the Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) get processed. By removing the need for manual follow-up tasks and automatically submitting status updates based on each payer’s adjudication timeframe, providers can improve productivity and get paid the correct amounts faster. The claims management process is fraught with challenges. But with the right tools, data and analytics, these hurdles can be overcome. By integrating pre-claim (encounters) and post-claim (837) claims management software into the revenue cycle workflow, it's easy to review every line of every encounter. In this way, providers can verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement. Simply getting paid may not yet be as easy as providers would prefer, but technologies like Contract Manager and Contract Analysis, with their reliable customer support, can certainly oil the wheels. Find out more about how Experian Health’s Claims Management solutions with global payer edits and custom provider edits can help providers streamline the payment process and improve efficiencies, simplify the process and ensure speedy and accurate reimbursements.

The Appropriate Use Criteria (AUC) program is due to come into full effect in January 2023 at the earliest. The program was established by the Centers for Medicare and Medicaid Services (CMS) to help providers order the most appropriate diagnostic imaging services. Failure to comply may result in claims denials. Any provider that offers these services to Medicare beneficiaries should amend their clinical and revenue cycle workflows now, to avoid payment penalties when the AUC testing period comes to an end. This article sets out what providers can do to learn, test and prepare for the AUC program, and what Experian Health is doing to help healthcare providers manage these changes and minimize the risk of denied claims. What is the Appropriate Use Criteria program? The AUC program was created through the Protecting Access to Medicare Act of 2014 to help ensure that diagnostic imaging services would only be provided where medically necessary. No one would argue against evidence-based care. However, accessing that evidence can be challenging. Easy-access online tools are intended to make this easier. They have also been shown to reduce the overutilization of high-risk, high-cost imaging services. Under the program, any time a physician (or a member of their clinical staff) wants to order imaging services such as magnetic resonance imaging (MRI) or computed tomography (CT) for certain Medicare patients, they’ll need to consult an electronic Clinical Decision Support Mechanism (CDSM). This is especially important in an academic teaching environment. This online portal will check the patient’s electronic health record (EHR) and determine whether the order adheres to AUC or not, or whether the AUC consulted was not applicable. After consulting the CDSM, the ordering physician will need to include the following data on the order they send to the imaging services provider: the CDSM they consulted the ordering provider’s National Provider Identifier whether the service adhered to the applicable AUC or not, or whether no criteria in the CDSM were applicable to the patient’s clinical situation. Any ordering professionals deemed to be outliers will be required to seek prior authorization. When the program is fully implemented, imaging service providers will need to ensure they have a certificate of compliance to secure reimbursement. Who will be affected by the AUC program? The program applies to any provider that orders advanced diagnostic imaging services that are delivered in physician’s offices, hospital outpatient departments, ambulatory surgical centers (ASCs) or independent diagnostic testing facilities. It applies to those that are paid under the Medicare physician fee schedule, hospital outpatient prospective payment system or ASC payment system. It does not apply to Medicare Advantage beneficiaries. Emergencies, inpatient services and certain hardship exceptions are exempt. If any of these exceptions apply, the ordering physician must record them on the claim using the appropriate modifier code. When do providers need to implement it? CMS confirmed that there will be no payment consequences for failing to include AUC data until the later of January 2023 or the declared end of the COVID-19 public health emergency. In the meantime, providers are encouraged to implement the program on a voluntary basis, which will help identify pinch points in the claims management workflow. Claims submitted before full implementation may still be subject to denial, so it’s worth getting the process right now to avoid unnecessary rework later. How can providers “learn, test and prepare” for the AUC program? Healthcare organizations that may be affected by the AUC mandate should consider the following actions to ensure they are fully prepared by the time the program is fully implemented: Check the AUC program requirements and identify which service lines and vendors will be affected. Choose an appropriate Medicare-approved CDSM that closely matches existing EHR and claims management processes. Most EHR vendors will recommend a CDSM that fits seamlessly with their solution. CMS has also provided a list of certified CDSMs, which includes free options. However, these operate as stand-alone systems that will be more challenging to integrate with existing workflows. Communicate changes to staff. Ensure all referring and rendering providers are aware of and trained on the requirements and encourage dialogue to clarify new ways of working. Consider the impact on claims management teams, and ensure staff are trained on the new requirements. Healthcare Common Procedure Coding System G-codes and modifiers must be reported in claims alongside primary and secondary diagnosis and procedure codes. Are staff aware of the new codes? Are additional staff needed to process claims and potential rework that may be required after the AUC program is implemented? Build in time for review, to check that new processes are compliant. Ideally, the CDSM solution will include reporting functions to monitor progress and identify potential outliers that may be subject to prior authorizations later. If the furnishing provider is different from the ordering provider, the furnishing provider should have a workflow to confirm AUC adherence. How can digital tools and automation help providers ensure compliance with Appropriate Use Criteria? While the goal of the AUC program is to improve patient care and help manage the cost to the public purse, there will be an administrative burden for staff. The growing volume and complexity of claims overrule any attempt to manage this manually. Instead, healthcare organizations should look at automating the compliance process to ensure accuracy, prevent denied claims and reduce staff costs. To help healthcare providers manage these changes, Experian Health enhanced the Medical Necessity application to generate informational alerts when a procedure needs to adhere to AUC or prior authorization for Medicare patients. Users will be able to use this alert as a sign to check the AUC has been adhered to. These tools also fit well with Claim Scrubber, which reviews every line of each claim to verify that it’s coded correctly and isn’t missing any vital information, before being submitted. Claim Scrubber has also been enhanced to incorporate billing modifiers that will help with overall compliance requirements under the AUC rules. Preparing for what’s to come Access to medically necessary services is at the heart of evidence-based care. However, in promoting this, the Appropriate Use Criteria program creates additional tasks for staff that need to be understood and managed efficiently. While there are currently no penalties for non-compliance, providers should use the testing period to proactively implement new processes to determine their efficacy. As healthcare regulation continues to evolve, healthcare organizations should take a holistic approach to the exchange of information between clinical decision-makers, service providers and payers to lay the groundwork for consistent, accurate and reliable claims. Find out more about how Experian Health’s Medical Necessity and Claim Scrubber solutions support the claims management process and help healthcare organizations adhere to the Appropriate Use Criteria program.

In the sixth article in our series on how the patient journey has evolved since the onset of COVID-19, we look at three ways to prevent claim denials and reduce the time to payment. Faster claims processing is at the heart of a better patient financial experience and reduces revenue leakage for providers. For more insights and strategic recommendations to improve the patient journey in 2021 and beyond, download the full white paper. Nearly seven in 10 healthcare leaders say claim denials have increased in 2021, with an average denial rate of 17%. Inefficient claims processing and claims management systems were already struggling, but the pressures of the pandemic are causing even more rejections. Vaccination programs, rescheduled electives, and residency relocations contributed to fluctuating patient volumes, putting extra strain on reimbursement workflows. Patients switching health plans, and missing codes for COVID-19 vaccinations and treatment caused further delays and errors. Payer rules for reimbursement of treatment for “Long Covid” remain unclear: the absence of research and standards means claims are rejected because there’s no agreed “medical necessity.” Slow processes, incorrect patient identities, and poor data management mean the upward trend in claim denials seen over the last five years shows that it is likely to continue. Denials create a fragmented experience for patients because they don’t know how much they’ll need to pay for care, and leaves providers battling to recoup revenue. An effective claims management system is critical for maintaining provider revenue, securing patient reimbursements, and promoting positive patient-provider relationships. Here, we recommend a three-part strategy that uses data and automation to get claims right the first time. Prevention is better than cure One of the primary frustrations for claims management teams is that the majority of denied claims are preventable. Many of the errors that trigger denials could be avoided if databases and records systems could talk to each other. Instead of a reactive response, providers should invest in tools that can proactively prevent mistakes and errors, to ensure they collect every dollar owed. Digital tools can analyze data to help providers weed out the vulnerabilities in their processes and keep up with payer changes. Incorporating such tools is a sensible first step toward reducing and recovering expenses. One option is ClaimSource, which helps ensure that all hospital and physician claims are clean before being submitted to a government or commercial payer. It unlocks access to extensive federal, state, and commercial payer edits, allows custom provider edits, and incorporates automation tools and customer support. Providers can become confident that their claims will be correct the first time. Improving the likelihood of approval is critical to provider profitability and makes for a smoother patient experience. Prioritize eligibility checks for cleaner claims the first time Experian Health’s revenue cycle management experts say that the number one reason for denials is inaccurate eligibility. A 2020 poll by the Medical Group Management Association (MGMA) backs this up: 42% of providers said inaccurate or incomplete prior authorizations were a top cause of denials. Most providers use a medical claims clearinghouse or have systems to check eligibility beforehand. However, if patient identities aren’t verified properly at every touchpoint in the healthcare journey, mistakes can creep in and cause confusion about eligibility. Similarly, if the patient needs additional treatment that isn’t covered in the initial authorization, the resulting mismatch could lead to a denial. Tools such as Prior Authorizations and Insurance Eligibility Verification can help providers validate patient coverage in under 30 seconds. These solutions integrate with ClaimSource to fill in the gaps of patient information and streamline the claims process. Patients will get better insights into what they owe, and providers can increase efficiency. Automate workflows to eliminate time-consuming errors with claims processing Providers are well aware that manual processing slows reimbursement and increases the risk of errors. Tools such as Prior Authorizations and Insurance Eligibility Verification can help by using data and automation to improve accuracy and efficiency. The Council for Affordable Quality Healthcare suggests that automation can shave 20% off claims processing times, which could translate to thousands of hours saved each month. With those extra hours, claims teams will be freed up to complete their lengthy to-do lists and focus their efforts on other priorities. In addition, automated workflows can help assign work to the right specialist, keep track of payer changes, and incorporate repeated identity verification checks to drive down denials. With a Denial Workflow Manager, providers can automate and optimize their entire denial management process to get real-time insights on denied claims. This system can eliminate manual reviews and quickly identify accounts for resubmission or appeal. It can be integrated with tools such as ClaimSource and Enhanced Claim Status, so providers can monitor claims, denials and remits on the same screen and accelerate the workflow. As the pandemic continues to pressure profits and patients come to expect more from their healthcare journey, it’s no longer reasonable to accept denials as a cost of doing business. To find out how Experian Health can help your organization reduce denials, recover pandemic losses, and improve the patient experience, contact our team today. Missed the other blogs in the series? Check them out: 4 data driven healthcare marketing strategies to re-engage patients after COVID-19 How 24/7 self-scheduling can improve the post-pandemic patient experience COVID-19 highlights an acute need for digital patient intake solutions Automated prior authorization: getting patients the approved care they need Getting a holistic picture of patients with social determinants of health