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Root Cause Analysis

Why pay a contingency fee for something you can fix?

Wouldn't it be ideal to have a partner that aligns its incentives with you and focuses on not only finding errors but also helping you understand why these errors are occurring in the first place? T3 offers and conducts systematic Root Cause Analysis that will help you do just that.

Payors are spending too much money trying to plug the holes and catch errors. T3 works closely with our client partners to provide a cost-effective approach to fix, repair and control issues that are found, so that you can focus on taking care of your members.

By housing our clients' claims, eligibility, authorization and other key transaction data sets within our AuditPoint Platform and also keeping track of the errors that have been identified and validated by our audits, we are able to conduct analyses that keep our clients ahead of the curve. We leverage this data to discover additional errors, develop additional audits, explore and validate hypotheses about root causes driving the errors, and help our clients estimate the financial, administrative and other impacts of changes designed to address these issues.

Using our sophisticated data mining and analytical capabilities, we delve into our clients' data to uncover drivers of erroneous claim payment profiles. Through an open dialogue with our client partners, we validate our findings and propose solutions that can be implemented further upstream to prevent erroneous claims being paid. At the same time we analyze the impact of these solutions and provide implementation recommendations so our client partners see entire spectrum of implications before making their final decisions. At T3, we believe in aligning ourselves with our client partners from start to finish and providing solutions that are right for them.

Issue Discovery and Exploration

Sometimes the answer is hidden deep in the data!

Not a week passes without someone coming to us and saying, “I think there may be an issue with…,” “Could you help me see if…,” or, “What if…” These questions are typically prompted when clients notice something out of the ordinary and suspect it may be driving errors in claims processing or submission.

Our subject matter experts are at their best when working on such questions. They mine the vast quantity of claims, eligibility, authorization and other operational data in our warehouse and confirm or deny the hypotheses around what might be happening and why. Such explorations often lead to creative new audits that can find the suspected errors and to the discovery of other unexpected errors.

Change Impact Analysis

How do you know what you are signing up for?

Fixing root causes often requires changes to systems and processes and retraining people. But how do you assess the extent of the impact you are likely to have on MLR or administrative costs, or on key providers or customers?

We can help. Using your claims data and our auditing and data mining technology, we can simulate the impact of various changes you might be considering to improve the quality and efficiency of your claims processing. For example, if you are considering making changes to the criteria you use to decide whether to pay, pend or deny services that meet various duplicate claim matching criteria, we can generate metrics projecting the number of claims you will pay, pend or deny in each of those scenarios. Knowing the extent of the impact and exactly who will most likely be impacted, you can then make more informed decisions about which changes to make, when to make them, and how to better prepare everyone affected by the changes to come.

Adjudication Assistance Audits

Changes to your Adjudication System are not always the answer

Adjudication Assistance Audits were developed by T3 to help address gaps in claim systems technology that prevented local implementation of various interventions contemplated by our client partners. These audits target known errors while letting correctly processed claims to go through. These audits have proven to be extremely effective to the extent that some of client partners would prefer using these audits within AuditPoint and avoid making changes to their claims systems.