Plan Client Success – CAVO Itemized Bill Reviews Managed Care Enterprise

/ ITEMIZED BILL REVIEWS /

National Managed Care Payer Saves $2M+ in 10 Minutes

 

THE CHALLENGE

 

A National Multi-line Managed Care Payer that serves as a central intermediary for both government-sponsored and privately insured health care programs saved $2M+ in 10 Minutes by leveraging our CAVO® end-to-end platform.

The organization was tasked with auditing one of their larger itemized bills (IBs) they needed to overcome: a $10,000,000+ claim that consists of over 300 pages. As with many companies, IB reviews were a time-intensive process due to the variety of formats and overall document length.

We introduced our CAVO® IB Review solution to the employees responsible for preparing and reviewing the itemized bill. They loaded the 36,000+ line-item document and then processed the claim through CAVO® IB Predict, which normalizes the entire IB regardless of format, and makes recommendations on line items likely to be adjusted based on CMS codes, industry standards, and organization-specific policies.

Leveraging machine learning and intelligent software, our full spectrum solution provides immediate predictions to decrease work time, as well as increase the accuracy and consistency of results. CAVO® IB Predict revealed $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.

 

THE OUTCOME

 

The traditional itemized bill review process drains time and money, with the additional cost of increasing administrative burden and provider abrasion. Using an antiquated IB review process, nearly a month is typically spent preparing a 300-page document so that it can then be reviewed. The manual review process then takes additional weeks of time.

 

By leveraging our CAVO IB Review and CAVO Predict solutions, this company was able to save millions of dollars and over a month of time…and this was on only one claim!

 

With technology like our CAVO® platform, time spent reviewing itemized bills is greatly minimized. CAVO® extracts data from an imaged IB and maps it into your current processes and systems, delivering the most accurate IB information in the industry. Our CAVO® platform provides an astounding 5x+ productivity lift. By leveraging our solution platform, one person can do the work of at least five people.

 

Look Into the Present Future of IB Reviews