Empower UR Staff to Get Better Payor Results
Healthcare facilities rely on insurance reimbursement to fund patient care. At the same time, facilities are facing increased scrutiny from payors. What if you had immediate access to data comparing denial rates by payor and diagnosis? Empower UR staff and facility leaders with the metrics they need.
Respond With Facts!
Perhaps you’ve suspected that certain payors denied reimbursement more than others, but you couldn’t prove it with quantified evidence. Historical facts allow you to stand firm against the payor giants!
Information is key. BHCC allows you to view real-time metrics to compare payor denial rates. On-demand reports allow you to compare results based on quantified evidence of medical necessity scores. A macro view quickly reveals approval outliers so you can improve processes and negotiations.
In this sample chart, Value Insurance (royal blue) denies 50% of claims for “Bipolar and related disorders,” whereas Sunrise Health Insurance (teal) denies only 30%.
On-Demand Reports Give You Control
Easy-to-use on-demand charts empower you to see how payors compare with their peers. This example compares the approval rates based on the evidence of medical necessity for three insurance payors. At a glance, you can see that “Value Ins.” (dark blue) underperforms. Comparing the same strength score (at the gray reference line), Value approves only 30% of claims, while “Sunrise Health Ins.” (green) approves 70%.
See the big picture or drill down into the details of denial rates by payor, diagnostic class, and evidence strength scores. Compare rates and lengths of stay so you can follow up regarding low approval outliers. You’ll be able to improve insurance payor management with data. Enter contract negotiations with the strength and information!
Ready to Learn More?
Would you like to see more? Contact us to schedule a live demo or receive additional information
