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Case Study

An US-based organization using payer coding and denial coding worked to...

Client Background

A USA based provider engagement organization, focusing on empowering and partnering with physicians to address the fundamental and longstanding problems of clinical and financial under-performance in a highly complex US healthcare environment


To minimize lost reimbursements and denials. One of the major problems is that a large proportion of rejected claims goes unattended and is never resubmitted. The problem in resolving denials and shorten the accounts receivables cycle. establishing a trend between individual payer codes and common denial reason codes. Identifying root cause for denial of billing, registration and medical coding to reduce future denials. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the normal trend is seen.


Analytics that focus on identifying the most productive opportunities to collect co-pays, co-insurance, deductibles and self-pay amounts during each stage of the revenue cycle. Identifying Root Causes and works with the appropriate teams (e.g. Patient Access, Coding or IT) to implement the required changes and bring the metrics within an acceptable range. Services that focus on ensuring the claims must contain complete, accurate data that results in timely, optimal payment. By applying a series of interrelated steps, including patient demographic validation, insurance mapping, and insurer-specific edits applied to diagnosis(ICD) and procedure(CPT)codes, Optimizing clients’ cash flows


End-to-end, analytics led an insightful reporting platform utilizing real-time data. Actionable BI with summary, drilled down, trended, KPI, scorecard-based dashboards. Big-data warehouse, integrating multiple types of data from disparate sources. Overall, one-stop solution for business, revenue increase, decision making, ad-hoc reporting, etc. Customer satisfaction.

Solution Highlights


Increase in customer satisfaction


Revenue Increased