SYSTEM AND BUSINESS
Programmatic solutions enabling your data to flow automatically while simultaneously incorporating insights that are “learned” from the data.
We specialize in identifying
cost-saving, user-friendly opportunities that automate manual processes for our healthcare clients
Working with new and mature technologies, the solutions we provide are robust, comprehensive and manageable. Years of experience consistently confirm: fine-tuning business processes with data automation is the best way for an organization to save time and money.
To learn more about our latest automation whitepaper: “How You’re Leaving Money on the Table and What to Do About It.”
Reliably and easily evaluate paid claims on a periodic basis for potential errors in pricing. Our automated system handles payer outreach, creating a cost-effective way to review overpaid claims and recoup misspent funds.
- In the past 12 months, one client has used 100% Audit to identify more than 13,000 overpaid claims—resulting in requests for recovery of more than $3 million.
- Since starting the process in 2010, our client has requested recovery on more than $14 million in overpaid claims.
Match patients to their ideal Primary Care Physician through automated analysis of provider encounter history. With Claims Attribution, ACOs have better visibility into patient care and can better measure PCP performance, resulting in simplified administration and improved patient experience.
- Since 2017 we have matched over 80,000 patients to a PCP for our client.
Easily upload, process, analyze and report on web-based data and operations. We build programs that automate payer claims, integrate CMS data and report on ACO requirements.
Byte Sized Solutions claims processing is a proprietary automation system using Robotic Process Automation (RPA) to handle the mundane and complex manual tasks of processing claims. Through our years of experience across many payors we have identified and mastered all the unique characteristics and requirements necessary for successful claims submissions.
- Better Claims Management
Reduce claims turnaround time
- Claims Viewer
See & search all payor claims in one location
- No More Errors
Eliminate reliance on human claims processing
- Error Resolution Tool
Quickly view all claims errors in one location
- Redirect Employees
Apply your team to higher value tasks
- Comprehensive Reports
Offer insight into claims processing analysis
- Get Claims Alerts
Monitor claims issues and provide notification
you struggling with automation
in your organization?
Check out our spotlight on Blue Cross Blue Shield for ideas on how automation could improve your organization.
Leverage Byte Sized
We have solved the following for our clients:
- Resolve missing member months and differences in BCBS data across lines of business, like member status.
- We know how to handle different data sets to appropriately deal with different rules in the eligibility data, like which eligibility groups have locked cohorts and which don’t.
- We’ve also had to deal with how claims might operate on a different methodology from eligibility, like if an eligibility cohort is locked but the claims leak across periods.
- We know how to determine the difference between what makes a claim unique and what is just noise in the data. For BCBS, we also know some of the different scenarios of a claim dropping off of a payor’s file and the different ways to handle that appropriately for the business, as well as how to extract the most from your data when some of the data is masked.
Motivation for Automation
Recover more money
Our automated claims submission has several built-in alerts to catch issues that may have been overlooked in the past. Searchable database makes it easy to review, follow-up and quickly resolve errors.
Reclaim your weekends
Claims submissions usually have windows of a few days per month where claims can be submitted and sometimes that falls on “off days.” When the process is automated, there is no need for staff to work the weekend.
Vacation and sick days, we’ve got you covered
Typically, the burden of manually submitting claims falls on the shoulders of 1 or 2 people in an organization. Automation eliminates the stress of scrambling to cover for the times when staff needs to be away.
Automating the claims submission process removes human error. The process is defined and executed the same each time eliminating the possibility of human error in the submission process.
Reduce staff hours
Our clients typically save 10-20 hours a month just on the mundane tasks required to manually submit BCBS claims. Free up those hours to focus on more important work.
Access to detailed executive summary reports that aggregate all claims data.