Mid-sized OBGYN provider based in Illinois.
- Claim rejection at the clearinghouse
- Claims were stuck in open balance or unsettled account
- Their AR buckets were rising
Plutus Health's Plan of Action
Our team prepared a detailed strategy to streamline clients' RCM processes.
- We started with a thorough analysis of their RCM process which uncovered existing gaps.
- Our team identified the reason behind major denials with our advanced denial and rejection analysis tool.
- Our denial management specialists identified analyzed the denial pattern.
- We worked on all the issues to deliver promising results.
- BCBS claims got denied for "Taxonomy codes missing on the claim form"
- BCBS claims denied stating, "Not enrolled with the payer"
- Contracts with insurance got terminated
- Credentialing and non-participating issues led to a significant loss in reimbursement
- Payment posting was out of TAT
- Untimely AR follow up
Plutus Health Solution
- We guided the client in enrolling backdated and resubmitted claims.
- Professionals from our team helped the client with TAT and posted all the payments.
- Plutus Health's highly experienced billers fixed the practice management billing system to remove the missing code issues.
- Our credentialing expert helped the client with backdated credentialing to reduce AR.
- Denial management specialists from Plutus Health addressed all the denied claims in 48 to 72 hours.
The client achieved uninterrupted cash flow in just three months of working with us.
- Generated revenue of over $245K from AR & denied claims.
- Brought down the AR days to minimum and denial rates below 5%