
Where They Needed Help
- Manual processes were overwhelming adjusters
- Adjusters were being presented with 100% of medical bills
- Bill review costs were incurred on 100% of medical bills
- Bills were not being adequately screened for appropriateness
How We Helped
- We auto-adjudicated 70% of all document types before bill review (leading to significant bill review savings)
- Relatedness and Rarity rules identified 26% of medical charges which were presented to adjusters for possible rejection
- 78% of system-identified, message-based rejected bills did not return for payment