Cene 100.000 $
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Leveraging Microsoft Power BI, Protiviti's Healthcare Claims Analytics Tool improves claim quality, reduces adjusted claims, reduces rework and increases visibility into the entire claim population
Protiviti’s customizable proprietary Healthcare Claims Analytics Tool leverages Microsoft Power BI to IMPROVE claim quality, REDUCE adjusted claims, REDUCE rework, and INCREASE visibility into the entire claim population as opposed to a sample for healthcare organizations.
Allowed Benefit Validation: Protiviti’s Healthcare Claims Analytics Tool has the capability to aggregate all claim data for one or more products (i.e. Medicare Advantage, Managed Medicaid, Commercial, etc.) and independently recalculate the allowed benefit amount based upon source data to determine if there is an error. The tool can assess claim data pre check run to prevent pricing errors and improve overall claim quality. The tool captures:
Member Cost Share Validation: Protiviti’s Healthcare Claims Analytics Tool can identify the accuracy of the member cost share payment by comparing the claim data to the benefit plan’s cost share structure. This can be applied to any product line (i.e. Medicare Advantage, Managed Medicaid, Commercial, etc.) The tool captures:
Benefits of Protiviti's Healthcare Claims Analytics Tool:
Pricing varies depending on size of environment and amount of data