Fast-Growing Dental Admin Support Organization Implements Data Processing with Snowflake to Improve Revenue Capture
Customer's Challenge
A leading dental admin support organization has struggled for many years to process EDI X12 data, causing millions of lost dollars in revenue stemming from claims pre-authorization and denial management issues.
phData's Solution
phData’s six-month data engineering project implemented Snowflake’s variant data capability and scalable capacity to make processing EDI X12 data possible.
Results
By the end of the engagement, the customer had a fully implemented Snowflake solution designed to effectively link claims submissions with claims responses to ensure correct benefits are provided to patients during service.
Snowflake’s scalable warehouse compute, unique capabilities processing, and ability to query semi-structured data were key success factors for this project. Using matching criteria designed by the business, claims adjudications, status responses, and benefits coverage details are now linked to claims submissions over 96% of the time, reducing patient overpayments, write-offs, and open payables. Additionally, the solution improved query time by materializing months of data in just 10-15 minutes.
The Full Story
A leading dental admin support organization partners with over 1,000 owner dentists to provide business administration support, allowing the dentists to focus primarily on dentistry and providing patients with the best experience.
The claims adjudication process is complex, and the data is difficult to structure in a usable fashion. As a result, the client has struggled for over 10 years to process this data effectively. Their attempts at using SQL Server and other platforms over the years proved unsuccessful, causing millions of lost revenue from claims pre-authorization and denial management issues.
One customer practice, in particular, is experiencing frequent claims denials and service substitutions, resulting in revenue impacts approaching tens of millions of dollars annually. The reports provided by their Electronic Health Record (EHR) revenue cycle management solution were insufficient to understand the trends and detect the patterns to improve the outcomes from their reimbursement.
Consequently, the client needed a solution that would trace the claim activity life cycle and create a consolidated dataset, providing the opportunity to effectively analyze and form an end-to-end picture of claim lifecycle performance.
Noted as one of Inc. 500’s “fastest-growing private companies in America” for the past 13 consecutive years, the client knew they needed a solution to increase revenue capture and ensure continued growth.
Snowflake was chosen as the data platform for ingesting and processing the claims received from insurance payers. Once translated to JSON format, Snowflake’s capabilities to transform semi-structured data increased visibility to proactively triage discrepancies and provided a foundation for implementing machine learning to build decision support rules into the provider workflows to reduce claim errors upfront.
Why phData?
The customer chose to work with phData because of the team’s technical and industry matter expertise to solve this challenge in a novel way. By enabling the client to proactively target pre-authorization and denial issues, they could address them well before they became a problem.
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