Healthcare insurance coverage is a necessity in the U.S. but it’s a complex system to navigate for both providers and patients. At Experian Health, we aim to simplify the administrative and operational sides of healthcare so improving the registration and insurance identification process for providers within the patient access workflow is an important problem we want to help solve.
With a myriad of insurers, plans and benefits coverage, along with complexities like multiple levels of coverage some individuals may have, providers have a tough task trying to coalesce all the right information when a patient registers for care in real time – so the searching and querying is often pushed out beyond the registration desk, creating manual rework, denied claims and delays in reimbursements. This downstream impact has been a huge pain point with claims denials contributing to hospitals and medical practices losing more than $200 billion dollars in lost revenue per year. A rejection not only impacts the provider but the patient too. If inaccurate information is submitted to a payer and the claim gets denied, providers don’t get reimbursed and patients could receive bills that they may not be able to pay.
We believe technology is the answer to solve many administrative challenges, which led us to acquire Wave HDC, a healthcare company that can deliver a real-time response. Identifying insurance coverage and benefits is a piece to the overall claims puzzle and this workflow has been ripe for improvement with better software. We believe we can now deliver the best solution in the market with this integration.
What is Wave HDC’s expertise? Their AI-powered healthcare data curation solutions utilize an “if-then” logic, returning multiple data points required for accurate patient billing from a single inquiry, in real-time (30-45 second processing time), during the registration process.
This innovation is a major step forward. No longer is a single response efficient as it pertains to uncovering a patient’s eligibility, coordination of benefits, insurance coverage and beyond. Our acquisition of Wave HHDC transforms the outdated clearinghouse model and will deliver immense benefits to our healthcare providers in the form of more accurate claim submissions and higher reimbursement rates, while also reducing manual work on their administrative teams. In fact, Wave HDC has prevented denials for its clients of over $1 billion dollars since 2020.
Reducing claims denials will have a major impact on providers as the industry faces many headwinds including inflation, complex regulations, and constantly changing payer rules that may hurt their financial stability. The issue is only getting worse; a 2022 Experian Health survey revealed that 42 percent of respondents see claims denials increasing and that uptick is between 10-15 percent according to a third of respondents. Additionally, 3 out of 4 survey respondents say reducing denials is the highest priority.
We are very excited to tackle this pain point with an advanced solution and welcome the Wave HDC team and these additional capabilities to Experian Health.
For more information about Experian Health, visit experian.com/health.