Case Study: AI Technology for Itemized Bill Review Optimization
A multi-state health plan engaged Advent Health Partners to increase their volume of itemized bill reviews, and by leveraging Advent’s medical review technology, CAVO®, increased their total financial value by 61% after 18 months. When the payer initially engaged with Advent, their ten full-time team members manually reviewed 7,500 claims annually. After implementing CAVO into […]
Advent Health Partners’ CAVO® Net Promoter Score® Results
Advent Health Partners is excited to share our Net Promoter Score®, where we asked our clients and partners to discuss their experiences using CAVO® and working with the CAVO support team to streamline their medical claims review processes. With a Net Promoter Score® of 80, Advent blew the average 2022 score for B2B Software & […]
Client Success Strategy [Video]
https://vimeo.com/613690679/f4d5350381?share=copy Our team invests in a strategic partnership with our clients, focused on minimizing denials and ensuring appropriate reimbursement. Advent’s clinical expertise, joined with revenue cycle technology, provides an unparalleled client success strategy. Our objective is to be the partner utilized to bridge current and future gaps within clinical reviews and provide detailed information and […]
Plan Client Success – CAVO DRG Validation Client
/ PRE-PAY / DRG / Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity using CAVO DRG Validation THEN → Chasing the Records Before CAVO DRG Validation, the record intake team gathers the medical records, depending upon facility, by: Utilizing third-party electronic delivery services, Obtaining encrypted disks from the facility, Accessing […]
Plan Client Success – CAVO Prepay IB Reviews
/ PREPAY REVIEWS / ITEMIZED BILL REVIEWS / Regional Health Plan Decreases Pre-Pay Hospital Bill Review Time by 500+% Per Case Using IB Reviews THEN This regional health plan has an internal team of RNs performing hospital bill pre-pay IB reviews. Nurse reviewers previously either: requested the itemized bill (IB) directly from the provider based on […]
Plan Client Success – CAVO Cost Containment Readmission Reviews
/ POST-PAY / Cost Containment Readmission Reviews Unit Experiences 6:1 ROI During CAVO® Kick-Off Training THEN Client reviewers had to first locate the records associated with the case. Next, reviewers located appropriate documentation within the case (e.g., ED notes, Admission notes, H&P) to find presenting symptoms and reasons for admission. Nurses then pulled up their […]
Plan Client Success – CAVO Post-Pay DRG Validation
/ POST-PAY / DRG / Large National Payer’s Post-Pay DRG Validation Team Achieves 300+% Productivity Increase with CAVO THEN This large national payer applies enterprise rules, edits, and analytics to all post-pay DRG claims to pinpoint “suspects” for potential overpayment, which are then reviewed by a team of RNs. Analytics were performed on claims that […]
Plan Client Success – CAVO Pre-pay DRG reviews at Regional Payer
/ PRE-PAY / DRG / Regional Health Plan’s Pre-Pay DRG Review Team Uses CAVO to Increase Productivity by 200% THEN RNs performed DRG validation reviews primarily from providers’ EMRs. Reviews were a page-to-page comparison (often averaging 500+ pages per case) within slow systems with cumbersome navigation. Once RNs located decision information, they created screenshots and […]
Case Study: Accelerating Medical Necessity Reviews With CAVO®
The Client A health plan is reviewing a medical necessity claim for a 50-year-old male with a neurostimulator placed for pain control related to chronic back pain and right lower extremity numbness. He is a former police officer injured while on duty with nine subsequent back surgeries resulting in post-laminectomy pain syndrome. He now requires […]
Case Study: Simplify DRG Reviews with CAVO®
The Client A health plan is reviewing a claim for a 35-year-old female with a prosthetic heart valve who presented to the Emergency Department complaining of rectal bleeding and a six-day heavy menstrual period. The patient was especially concerned because she takes Coumadin to help thin her blood and wanted to ensure she wasn’t bleeding […]