Claims Adjudication Optimization
Reduce inefficiency while increasing the accuracy of payment integrity in the claims adjudication process
From selection and implementation of new platforms to upgrades and optimization of existing operations, our advisory services team can help streamline the process. Altegra Health offers clients deep and unique experience with system integrations, data analytics, development and refinement of internal controls, regulatory guidelines impacting payment integrity, as well as common claim scrubber pitfalls that contribute to erroneous payments. This includes audit and assessment of third-party administrator partners. Our experts effectively and efficiently identify and provide solutions to remedy issues contributing to waste in the claims adjudication process – aligning the people, process and technology required for peak performance.
- Selection of New Technology – Whether drafting a request for proposal (“RFP”) or planning for an implementation, our advisory team can help manage the process of onboarding new technology. We can help evaluate vendors as well as features and functions to ensure the best fit.
- Platform Upgrades – Our advisors can assist in the assessment and identification of downstream ramifications associated with version changes and upgrades to help safeguard against unintended changes that can hinder workflows.
- Data Analytics – Altegra Health can assist in the development and deployment of analytic tools such as dashboards to consolidate key performance indicators, even merging data from disparate systems.
- Claims Adjudication Expertise – Our consultants have deep and unique experience with internal controls, compliance and a wealth of experience with what commonly contributes to erroneous payments, delays and denials.
- Third-Party Administrator Review – We offer a proactive approach to reduce unnecessary cost related to healthcare administration by providing in-depth assessment of third-party administrator operations. We ensure the most timely and accurate processing of claims on our clients behalf.
For more information, contact:
Melissa Scott, CHC, CPC
Director, Advisory Services Division
Office: 310.776.4500 Ext. 2370 | Cell: 951.440.4920