Category: Case Studies

Helping Ensure DME Claims Are Paid Correctly

The Challenge:

Due to the multitude of services, procedures and policies involved with DME, a large health plan with close to 4 million members was unable to capture all the claims it needed to review for correct billing, frequency accumulation, benefit application and payment per their new policies. With a two month time frame to launch, they needed to come up with a solution quickly, and they turned to T3 for help. Continue reading Helping Ensure DME Claims Are Paid Correctly

Automation with AuditPoint platform results in substantial savings of time, resources and money

The Challenge:

A health plan with close to 4 million members had developed more than 30 internal queries to identify potential duplicate claims. Managing these queries was extremely resource-intensive and cumbersome. The payor found that they abandoned more than 50% of their potential 325,000 duplicate claims inventory annually simply because they couldn’t get to it in a timely manner. Additionally, the vast majority of what they did manage to review was not worth looking at as those claims turned out to have been paid correctly. They knew they were leaving money on the table.

Continue reading Automation with AuditPoint platform results in substantial savings of time, resources and money

Customer Member Liability Audits Ensure Claims Accuracy

The Challenge:

The complex plan designs introduced by the Affordable Care Act have created a configuration and plan administration challenge for payors selling HIX plans. Large carriers with business in multiple states have an even greater challenge, as each state can further customize these plans. A Blue Cross Blue Shield plan with millions of members in many states reached out to T3 to see if we could help them ensure that the applicable benefits were being administered correctly by them, especially as it relates to mandated benefits and member liability.

Continue reading Customer Member Liability Audits Ensure Claims Accuracy