Challenge

Improve claims processing speed and accuracy during growing demand for health services in a manner consistent with the broad data compliance and security requirements of Signature Performance serving a government customer.

Success highlights

• Achieved a claims auto-adjudication level of 94%, an increase of more than 30%
• Achieved an accuracy rate of 98% for claims processing
• Auto-adjudicated over seven million claims in the first year of operation
• Addressed the government client’s compliance requirements with deployment of the Trizetto® Facets® core administration platform in the Microsoft Azure ^™ Government cloud

Challenge

Improve automation for El Paso Health to handle growing claims volumes.

Success highlights

• Increased market share to 17% through efficient processes
• Increased claims auto-adjudication rate by 8.7%
• Increased provider satisfaction scores by nearly 15% with utilization and quality management and 20% with network/coordination of care
• Achieved 100% automation on reimbursements for complex diagnosis-related group (DRG) contracts
• Achieved 100% automation of appeals and grievances as well as full compliance with Texas Medicaid regulatory guidelines

Challenge

Improve front-end patient access by focusing on up-front payments and prior authorizations for a large US-based health system.

Success highlights

Significant increases in up-front patient collections, accelerating over time:

• 49% increase in up-front collections in the first six months
• 304% increase in up-front collections in the first year