IBM > 实例探究 > 使用 IBM Cloudant 彻底改变医疗保健索赔拒绝

使用 IBM Cloudant 彻底改变医疗保健索赔拒绝

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技术
  • 应用基础设施与中间件 - 数据库管理和存储
  • 平台即服务 (PaaS) - 应用开发平台
适用行业
  • 金融与保险
  • 医疗保健和医院
用例
  • 时间敏感网络
  • 基于使用的保险
服务
  • 云规划/设计/实施服务
关于客户
Advent Health Partners (Advent) 是 Powered Health 集团的一部分,致力于为医疗保健提供者带来最大的财务回报。它使用 CAVO 技术提供索赔上诉服务,对被拒绝的索赔进行编码更正——既作为外包服务产品,又作为独立产品。
挑战
医疗保健法规的快速变化和繁琐的索赔处理导致美国医疗保健收入周期效率低下,数十亿美元被拒绝的保险索赔所困扰。
解决方案
Advent 使用 IBM Cloudant 来支持其 CAVO 工具,将审核索赔所需的时间缩短了高达 500%,从而加快了医疗保健收入周期并帮助医院收回了数百万美元。
运营影响
  • The implementation of CAVO has transformed the way appeals, documents, and information is managed, generating valuable returns for its customers. It has allowed Advent to be highly competitive in the saturated denial of claims market, as it can review and process claims denial cases much faster than other service providers. The improved efficiency has also delivered impressive savings on the highly-skilled staff needed to perform such work. As teams can work through a higher volume of cases, Advent has been able to maintain relatively flat staffing levels, even as its business has grown. The time saved on low-level work empowers these clinical workers to focus on more value-added tasks. Furthermore, Advent’s new approach is delivering a massive financial impact for clients too. As CAVO makes it less expensive and time-consuming for hospitals to appeal claims, they are more likely to recoup valuable dollars from appeals.
数量效益
  • Up to 500% faster claims review
  • Millions of dollars returned to hospitals for services provided
  • Improved efficiency of analysts so they can review more claims annually

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