National Managed Care Payer Saves Over $2 Million in 10 Minutes

A National Multiline Managed Care Payer serving as a central intermediary for government-sponsored and privately insured healthcare programs needed to audit one of their larger itemized bills. The extensive audit would be a time-intensive process involving a variety of formats and long documents. To help optimize the process for speed, efficiency, and accuracy, the Managed Care Payer sought expert support from Advent Health Partners and our industry-leading medical record review technology, CAVO®.

The Challenge

The Managed Care Payer was tasked with auditing one of their largest itemized bills, which meant overcoming a $10,000,000+ claim with an over 300-page document. Like many companies, IB reviews were time-consuming due to the various formats involved and overall document length.

The traditional itemized bill review process is known to drain time and money with the added costs of increased administrative burdens and provider abrasion. Antiquated IB review processes take nearly a month to complete for similar-sized documents, with several additional weeks of manual reviews.

The Solution

We introduced the CAVO IB Review technology to the Client’s employees responsible for preparing and reviewing the itemized bill. They loaded the 36,000+ line-item document and processed the claim with CAVO IB Predict, which normalizes the entire ID regardless of format. The software also makes recommendations on line items likely to be adjusted based on CMS codes, industry standards, and organization-specific policies.

Leveraging CAVO’s machine learning and AI capabilities, Advent Health Partners could deliver immediate predictions that decreased work time and increased the accuracy and consistency of results.

The Outcome

Leveraging our CAVO IB Reviews and CAVO Predict solutions, the payer saved millions of dollars and a month of work on just a single claim. CAVO IB Predict uncovered $2,000,000+ in charges that could be removed before any intensive review began, and the RNs finished validating the results in less than 10 minutes. With technology like CAVO, time spent reviewing IBs is greatly minimized. CAVO extracts data from an imaged IB and maps it to your current processes and systems, delivering precise IB information. With CAVO’s technology and comprehensive support from the experienced team at Advent Health Partners, the Managed Care Payer achieved a tremendous productivity boost of more than five times.

The Advent Health Partners Answer

CAVO® is an enterprise technology platform that streamlines the medical record review process by providing solutions to your payment integrity challenges in one place. With an open API and a HIPAA-complaint-certified framework, CAVO reduces your organization’s time to revenue and improves efficiency across the board. The Advent Health Partners team has strong clinical and claims knowledge to assist your organization with mapping between siloed systems, and our data science team helps you break down complex processes with AI and machine learning. 

With over one million completed case reviews, CAVO delivers technology proven to scale up your medical record reviews and increase your team’s productivity by over 300%.

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