Elevating Future-State Operations
Case Study Aug 18, 2022
Our ongoing partnership with Tegria allowed us to solve the problem quickly without taking away from our high-priority work. We benefit greatly from their expertise and consider them part of the team!Sandra Jones, Director, Insurance Follow-Up, Novant Health
Rooted in the belief that healthcare doesn’t have to be confusing, difficult, or disconnected, Novant Health saw an opportunity to simplify its claims management process. Novant Health processes claims across multiple provider and payer systems with more than 640 locations spanning four states.
Novant Health team members were unnecessarily spending time manually researching “no response follow ups,” or claims awaiting a payer response. Often, no action was needed, but staff members couldn’t see this without working through each step of the follow-up process. This resulted in between three to thirty minutes of unnecessary follow-up time for each claim.
Tegria’s experienced analysts worked with Novant Health’s revenue cycle leaders to design a solution to streamline claims statusing and prevent unneeded follow-up. To allow internal teams to stay focused on vital day-to-day operations, the Tegria team took on the analytical groundwork, reviewing historical work queues and assessing claim inflow and outflow. These insights helped the team develop routing and timing logic to hold claims until they needed to be worked—allowing staff to prioritize those claims that truly needed to be worked right away.
The solution enabled the system to automatically defer certain claims and incorporate claims status information into the clearinghouse.
By strategically prioritizing claims statusing, the solution dramatically decreased time spent unnecessarily following up on claims, while maintaining work queue expectations and avoiding backlogs.
The graph below illustrates the number of no-response follow-ups.