ARC has developed a business intelligence application that brings the facility claim auditing process under control. Our technology reduces the time required to audit a facility claim and its accompanying itemized bill by 50% to 95%, while simultaneously increasing the accuracy of the audit.
Our Facility Claim Editor or “UB Editor” is a hosted application that delivers a quicker, easier way to identify deniable items on facility bills. Functionality of the application includes:
- Automated facility claim editing
- Character-matching algorithms to easily identify deniable items
- “Denial-Learning” functionality to automatically suggest previously denied items
- Manual itemized bill search, sort and filter capabilities
- Notes functionality at the full claim or claim line level
- Reporting and exporting tools
- Robust metric tracking for management and reporting purposes
- Team collaboration tools
- Increased savings opportunities
- “Learning” application
- Increased audit accuracy
- Reduces provider appeals
- Decrease auditing time
- Free up analysts time to engage in more thorough (clinical) reviews
- Provides insurers the tools for data mining
- Provides strong data sources for ongoing provider contract negotiations
- ROI of 5:1 or better
STANDARD REPORTING: UB Editor has several customizable reports currently available which can be exported to .xls format. Additional standardized reports can also be developed as identified by the audit team and/or management.
AD HOC REPORTING: It is our goal that users have the ability to run desired reports quickly and easily. However, should the need arise to run reports that are not currently available through the application, ARC will respond to the need for ad hoc reports.
ARC recently had the opportunity to test its UB Editor application to a large payer on several test claims. The largest claim in the proof of concept was a $1.7 million. The results are detailed detailed below.
|CURRENT PROCESS||UTILIZING UB EDITOR|
|Time to complete audit||5 – 7 days||2 hours on this claim
15 minutes on future claims
|Deniable items identified||Approx. $180K||Approx. $240K|
|Time to compile results||Approx. 30 – 45 minutes||Single click action (less than a minute)|
|Accuracy||Approx. 60% – 90%||98%|