Sushil Ghorpade
Overview
A large multi-specialty healthcare provider in Texas faced numerous challenges, including unprocessed claims, high-volume B2B payments, and work backlogs. Seeking a comprehensive solution, they turned to PCH Health Solutions to revolutionize their operations.
Challenge
- Numerous claims waiting to be processed
- High-volume unprocessed B2B payments
- Work backlogs, flawed workflows, and delays in work
- Multiple handoffs for payments and claims
- Ineffective payment and claim processing system
PCH Health Solutions
PCH Health provided the client with a one-stop solution to process payments and claims:
- Utilized PCH Health's payment processing platform, TMS, to deposit checks received by customers, instantly reducing the TAT for deposits.
- Processed Explanations of Benefits (EOBs) were using PCH Health to generate 835 automated files.
Results & Benefits
- Reduced the client's TATs using our augmented payment and claims processing solution.
- Developed resiliency for the client using PCh Health's hub-and-spoke model to support the new process, avoiding adverse impacts with a robust DR solution.
- Reduced handoffs between deposits and reconciliation.
- Achieved same-day deposits.
- Completed reconciliation within 48 hours.
- Processed exclusive volumes for the organization, amounting to a $16 million ACV engagement for the next 12 months.
- Achieved significant scalability using a fully variable solution model.
- Gained access to an extensive set of platform tools.
- Offered customers add-ons to up-sell products and services, benefitting the end customer.
- Reduced efforts for all stakeholders – the Payer, the Provider, and the Bank.
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