ISSUE:
Facing increased economic pressure, a multi-billion dollar health system was determined to find additional revenue enhancement opportunities by fixing costly internal inefficiencies and revamping poor processes. After an initial assessment of their contract management system, Apollo identified nearly 2% of new net revenue from underpaid accounts. The analysis also showed that the hospital's existing system and staff was unable to interpret the complex contract logic and could not scale to analyze the large claim volume that resulted in millions of lost revenue.
SOLUTION:
Apollo's proven predictive analytics identified $15 million by analyzing the last 12 months of historical claim data. The Apollo Underpayment Recovery Solution analyzed every claim including low-dollar and leveraged bulk automated appeals to ensure all accounts were paid. In addition, the solution continuously flags new claims daily to proactively identify underpayments capitalizing on any timely filing restrictions. Apollo's work-drivers also provided the representatives with a more efficient follow-up process for experimental drug denials.
RESULTS:
 Identified more than $15 million in less than six months
Automated a batch appeal process to collect on every claim
Implemented workdrivers to flag underpaid claims daily
Improved collections on experimental drug denials
Provided detailed reporting to support contract negotiations
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