Delivering Sustainable Revenue to a Leading Stop-Loss Carrier

by | Aug 19, 2017 | Case Studies

SITUATION:

A leading German stop-loss insurance carrier with a presence in over 150 Managed Care Payors was struggling to avoid unnecessary overpayments and high-dollar stop-loss claims. They needed a process in place that could predict internal contract failures based on a live audit process and tests of each Payor component within the stop-loss contracts to avoid future costly mistakes.

PLAN2ACCOUNT SOLUTION:

Phase 1:

Plan2Account imported and merged data sets of the 150 Payors to rebuild the missing data.

Phase 2:

Data standardization, normalization, corrections, calculations, verifications and enrichments were performed.

Phase 3:

Transactions were tracked to contracts with payments and referral error accuracy on the basis of refined and processed data.

CLIENT RESULTS:

Plan2Account was able to identify the largest source of errors, calculate the efficiency losses in overpayments, and suggest improvements, including establishing a dashboard for problem resolution acceleration. Plan2Account provided easy access for monitoring and visualizing data through our proprietary auditing software, allowing the client to forecast payment mistakes in advance, saving potentially millions in overpayment losses.

 

The client reduced overpayments by 3.5%, resulting in increased revenue and stability.

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