Millions Recovered For Expansive Hospital System Through Artificial Intelligence And Business Intelligence Software

by | Jun 16, 2018 | Case Studies

SITUATION:

An expansive $6 billion hospital system had a diverse Payor contract base and was unable to successfully monitor payment quality through reporting, therefore continuing to lose millions in underpayments. The client needed a solution for the continuous, systematic monitoring of contract payment quality and real-time alert reporting.

PLAN2ACCOUNT SOLUTION

Phase 1: Custom Data Sets Reverse Engineered

Plan2Account began by re-adjudicating all transactions going back 5 years with a 100% audit of payments.

Phase 2: Real-Time Payment Monitored

Through advanced AI and a predictive auditing and modeling process, Plan2Account set up automated contract auditing with real-time mistake identification before the Payor pays a claim.

Phase 3: Live Gathering of Data

Data from all units began compiling and reporting to a secure Plan2Account data center dedicated to the client.

Phase 4: Analyzed and Reported on Each Identified Code Issue

The reported, analyzed and archived data provided maps, charts and real-time alerts for speedy issue identification and resolution.

CLIENT RESULTS:

Plan2Account integrated an online access client dashboard ensuring real-time alerts of payment errors to assist decision making from any computer or smart device. This allowed the client to identify $100 million in payment errors and reduce future payment mistakes, increasing contract productivity and system sustainability.

 

Plan2Account secured Payor settlements of $30 million into the hospital system’s bank account.

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