Transform your collection and denial management process with CDMS

Case Study 01

Problem

A large diagnostic lab client is faced with fluctuations in claim volumes and denials as a result of COVID-19.  How to address the spikes in volume without incurring large overhead costs?

Solution

SYNERGEN Health's Predictive Denial Management System (CDMS) was deployed. This fully integrated knowledge management solution automatically suggests fixes specific to each denial case. As a result, the staff was able to work efficiently to make accurate denial decisions. Rule engines execute collective fixes to require less human involvement and as a result, shifts in the increase in denials were managed timely with minimal staff intervention.

Impact Stats

Case Study 02

Problem

Denial management to ensure fair reimbursement is heavily dependent on manual claim touches by the staff.

Solution

Predictive analytics is based on using historical data, machine learning, and artificial intelligence to predict what happens in the future.  The historical data is modeled to examine key trends and patterns in the data. The model can be applied to the current data to predict what will happen.

As an example of work queue management: Workflows can be prioritized into queues based on action required to assist the staff by managing the actions required timely and efficiently despite increases in claim volume.

Impact Stats