Is a data warehouse a necessity for your healthcare organization?
About 90 percent of physicians now file most or all claims through electronic data interchange (EDI), surveys show. The increased use of EDI has produced logistical efficiencies for both providers and payers, but payers have benefited most from the analytical capabilities enabled by EDI.
Payers, particularly large insurers, collect and analyze huge amounts of electronic claims data, such as scrutinizing the amount and type of claims submitted by an individual physician or hospital. Until recently, it was difficult for physicians--particularly those in small groups--to take advantage of EDI analysis.
Healthcare Digitals now has a solution for you
We are creating an advanced software program that uses different tools to extract, transform and analyze data in the warehouse. Most medical groups focus on optimizing revenues and maximizing clinical staff time. The software can prepare many reports, including denied claims, coding practices, referral sources and accounts receivable. Advanced programs can produce easy-to-read reports in formats that are easy to understand and are familiar to administrators and staff.
- Physician practices can gain value by capturing and analyzing data at two key points in the claims payment cycle. The first is when the claim has been recorded but not yet transmitted to the payer. At that time, the practice can run the claim through a scrubber or edit engine, which allows it to be reviewed for accuracy before it is sent to the payer.
- The second opportunity is at receipt of payment, when the practice can analyze denials and allowables. A sophisticated business logic application identifies and prioritizes denied claims, enabling managers to solve the most financially significant problems first. The software can also sort claims by payer and procedure. Managers can view reports that identify payers that consistently deny or edit specific types of claims. Such information can be helpful in negotiating future contracts with payers.