ABA Claim Denials reduced to less than 5% with Plutus Health Solutions

The Client

A large-sized client is planning to expand their ABA services by acquiring groups of ABA service providers across the USA.

Challenges Faced

• Inefficient communication and coordination between care providers and their prior RCM service providers.
• Delays in addressing aged claims and high credential denials
• Lack of reporting of global AR issues like payor behavior/credentialing led to accumulation in the receivables.
• Incorrect denials by major payors which were not identified on time and escalated.
• Lack of tools and technology to identify gaps and prioritize interventions

Plutus Health Plan

Plutus Health's experts recognized that the client needed an advanced analytics solution. We offered our expertise in healthcare analytics, technology, and risk adjustment methodologies to address the challenges faced by the payer.

Results

• The client saw a significant improvement in the denial % to less than 5%.
• Reimbursement has increased to 98% of the monthly billed charges.
• Days in AR is ~21 days, much better than industry standards.
• Risks of adjustments due to delayed filing have reduced significantly due to timely follow-up.