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Case Study
Halifax Health Drives Clean Claims With Automated Healthcare Claims Management
Integrated, exception-based reimbursement management and analytics solutions track claim status, providing visibility into revenue cycle performance.
Integrated, exception-based reimbursement management and analytics solutions track claim status, providing visibility into revenue cycle performance.
Without Automation, Keeping up with Changing Billing Rules was a Struggle
As payer rules and billing codes change rapidly, Halifax needed greater visibility into its claims management process to prevent payment delays, denials, and rework.
“To stay right in step with the insurance companies, we have to be proactive. We create edits to make sure that the claims go out correctly according to the way the insurance wants to be billed the first time.”
Kathleen Mitchell - Billing Supervisor, Halifax Health
Cleaner Claims, Better Visibility, and a More Efficient Healthcare Claims Processing Workflow
Halifax Health can now see how many claims it has submitted and how many have been accepted. In-depth analytics help the health system identify and correct the root causes of potential problems.
Assurance Reimbursement Management™
Improve first-pass claim acceptance rates with comprehensive edits.
This cloud-based, analytics-driven claims and remittance management solution helps Halifax improve efficiency with just-in-time claim follow-up. The solution gives Halifax greater visibility into the claim lifecycle and helps the health system:
Capabilities
- Stay compliant with changing rules and regulations via 837 institutional and professional edits, plus Medicare CCI, Medical Necessity, 72-hour compliance, and optional eligibility edits
- Build its own custom edits and bridge routines for specific insurance lines
- Minimize rework with real-time claim editing capabilities within its HIS workflow
- Manage its secondary claims volume through automatic generation of secondary claims and EOBs from the primary remittance advice
- Track claims via a color-coded dashboard, which shows where each claim has been received, released, or accepted
- Manage denials in the same system as the rest of its claims, leveraging integrated denial and appeals management tools
Acuity Revenue Cycle Analytics™
Drive operational improvements with near real-time revenue cycle performance data.
Halifax Health uses Acuity Revenue Cycle Analytics to gain cross-functional visibility into its billing behaviors, processes, and trends. The health system uses the solution to:
Capabilities
- Keep track of how many claims it bills for a specific period, as well as how those numbers trend over time
- Monitor its revenue cycle performance, identify root causes of potential problems, and ensure it continues to meet high billing standards
- Access digestible data across multiple functions and revenue cycle systems
- Measure its performance against financial outcomes using threshold alerts and data-driven performance recommendations
- Fine-tune its processes to ensure the highest possible acceptance rate