SAI Global Introduces Claims Denial Manager for Healthcare Providers

Additionally, the company announced significant enhancements to its Claims Audit Manager application, which functions as a “Virtual Audit Coordinator”. Company officials said that it enforces deadlines and due dates throughout the healthcare organization and provides alerts to ensure effective management of complex appeals processes and avoidance of automatic revenue recoupment.

The enhanced Claims Audit Manager increases the level of automation. It comes with a new underlying architecture that enables a higher degree of configuration by the customer. Company officials said that this includes the ability to customize application forms and add customer-specific data fields.

Additional enhancements include a variety of pre-configured reports and a new graphical report layout designer to easily create custom reports.

“Market acceptance of our Claims Audit Manager application has been outstanding,” said Steve McGraw, president of governance, risk and compliance (GRC) products at SAI (News - Alert) Global Compliance. He said that the company estimates that its hospital customers have successfully appealed claims audit denials totaling $40 million in legitimate revenue with the support of the Claims Audit Manager, and substantially more is pending in active appeals.

“Based on this success and specific requests from our customers, we've developed the new Claims Denial Manager application,” he said, adding that in combination with the Compliance 360 Claims Audit Manager application, healthcare providers will have the complete visibility needed to monitor and proactively manage all of their financial exposure stemming from pre-payment and post-payment claims audits and denied claims.

The company has specifically designed the new application, Claims Denial Manager, to help minimize revenue loss due to pre-payment claims denials, primarily from commercial payers.

With the new offering, healthcare providers can manage the claims denial process with the tools needed to quickly identify and analyze denied claims. They will be able to increase accountability and ultimately improve net revenue capture, said company officials.

Dr. Larry Hegland, chief medical officer for Ministry of Health Care, noted that payment denials from health insurance organizations are a constant challenge, creating additional pressure on the bottom line for most healthcare providers.

“As both sides of this equation strive to maintain revenues and margins, we expect to see increasing challenges from claims payment denials,” he said.

“We are glad to see that SAI Global has leveraged the experience gained with their widely deployed solution for managing RAC, MIC and other government-driven revenue audits to design and deliver this new application for managing pre-payment denials.”

The enhanced version of the Claims Audit Manager and the new Claims Denial Manager application are now available.

Recently, the company and ErmsCo announced the integration of the ErmsCo ERM Foundation and the Compliance 360 GRC platform.

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