Multi-State Integrated Health Network

Streamlining Claims Processing and Payments With Reliable, Centralized Data 

What if a consolidated, automated MDM solution could proactively address inconsistent data that would otherwise result in unbilled or denied patient claims?


Our client is an integrated system of 15 nonprofit medical centers with more than 1,600 physicians in nearly 700 locations. Its team members care for patients and communities in North and South Carolina, Virginia, and Georgia.

Siloed Data Resulting in Denied Claims

Healthcare providers need to seamlessly integrate provider data from multiple siloed point-of-care systems to prevent small variations in how the data is captured and processed. Data inconsistencies across these systems can significantly impact operations, resulting in decreased revenue realization and a frustrating experience for both providers and patients.

For our client, siloed, inconsistent provider data was causing claims to be improperly matched and processed, resulting in denials for valid covered services. Our Agile practitioners recognized this challenge as a prime use case for Informatica, which the provider had recently implemented. The automated solution would compare, streamline, and harmonize patients data in order to establish a single, reliable source of truth and boost claims processing efficiencies.

A nurse working on a tablet.

Consolidating Systems Into a Single Source of Truth 

Leveraging Agile methodologies and project management, we built a shared vision across multiple organizational stakeholders to focus on high-impact business use cases and, importantly, prepare and enable teams for the new solution’s rollout.

We built an automated solution on Informatica’s Data Quality and Master Data Management Hub to ingest, cleanse, compare, and consolidate data between various internal and external sources, proactively identifying mismatches for quick resolution.

We established a Center for Enablement (C4E) to oversee information governance and resolve process gaps across multiple workstreams. We helped establish information as a shared asset at the enterprise level while ensuring information quality and data transparency.

Data quality improvements achieved with this solution significantly reduced the cost and complexity associated with integrating newly acquired hospitals and continues to accumulate value month over month. 

Results

Several doctors having a meeting, one older female doctor is talking.

Increasing Revenue and Improving Cycle Processing With Automation

The provider achieved its total cost of ownership in a fraction of its anticipated timeline. In the first year, our MDM solution expedited claims payments of more than $4 million in revenue. Over time, claims denials caused by incorrect provider data will drop by 80%.

Data quality improvements achieved with this solution significantly reduced the cost and complexity associated with integrating newly acquired hospitals and continues to accumulate value month over month. Our client’s teams can focus on higher-value activities and trust and leverage the data for greater business insights with less manual intervention.

The automated solution increased the frequency of successfully billed patient claims and limited confusion and frustration associated with providers’ attempts to understand and reverse denied claims.

Our deep expertise in working with healthcare data, business processes and technology, and solution integration and implementation projects enabled us to provide a modern, sustainable solution that vastly accelerated the provider’s revenue realization cycle.

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