Claims Intelligence

Claims Intelligence Solutions help healthcare practices & providers close the payment efficiency gap quickly and cost-effectively.

Systech’s Claims Intelligence solution optimizes cash flow and improves collections by bringing complex patient accounting data into a unified view. Predictive Analytics immediately uncover errors and ommisions in claims – even before they’re submitted, while the robust Business Discovery Platform exposes bottlenecks, gaps, and outliers in the revenue cycle. Our reporting and analytics tools help healthcare organizations improve daily work practices by uncovering systemic reasons for claims denials and underpayments. With big-picture insight you can optimize financial management processes and maximize revenue even through the evolving healthcare financial landscape.

“Mid-Cycle” Defined

The “mid-cycle” refers to the middle of the revenue cycle, between patient access and the business office, where clinical operations affect revenue. In the shift from volume to value, the mid-cycle is where improvements will have the greatest financial impact.


A Comprehensive Business Discovery Platform

Real-Time Visibility into Key Revenue Metrics & Top-Level Opportunities

An executive dashboard provides hospital leaders quick and easy access to operations & performance opportunities from across the enterprise, in a single holistic view.

Pinpoint Root Causes through Denial Management

Operational snapshots allow you to identify where improvement initiatives are needed most and determine their revenue impact. Granular data analytics enable analysts and other front-line personnel to pinpoint performance metrics to address root causes. You can drill down into attending physicians, the number of claims coded for a specific diagnosis, and specific benchmarking variances. It offers the detailed, actionable data you need to ultimately enable clinical operations drive financial improvements.

Create & Guide Interventions with Role-Based Insight

Role-specific views enable you to devise documentation and coding interventions and track them over time. Customizable dashboards, top-level metrics, automated alerts, and collaboration tools give directors and managers the tools they need to drive change.

Gain a Holistic View of the Claims Lifecycle

Systech’s claims tracking functionalities compiles all information in the life of a claim from various reports, information systems and departments- all in real-time – into one easy-to-navigate view.

Optimize Overall Revenue Performance

Measure and monitor progress of claims cycles & improvement initiatives with KPI’s that ensure you are on track for revenue targets. Drill-down capabilities and What-If analyses allow directors or managers pinpoint what strategies would lead to greatest impact on bottom line. 

Detect Errors in Payments and Fraud Risk

Revenue data and claims processing transactions enter the analytics engine as real-time inputs to recognize anomalies in payment patterns by each network provider to ensure revenue integrity with expected reimbursements.

Gain Control of the Revenue Cycle by Understanding Future Cash Flows

Predictive cash flow analysis, based on historical and current performance trends, provide visibility into expected cash flow, while highlighting revenue at risk – at any point within the revenue cycle. Automated alerts help you stay on target with revenue benchmarks and manage month-end reserves.

Improve Billing Efficiency with What-If Scenario Modeling

Leverage your historical data to understand trends and drivers of revenue cycle. What-If analyses enable users to implement hypothetical improvements and predict how those initiatives would affect revenue cycles, operations, and medical coding & billing practices.

Manage Compliance & Thrive with ICD-10 Standards

Monitor ICD-10 usage and compliance to capture underutilized diagnosis codes, isolate coding and billin process bottlenecks, and identify missing documentation concepts that drive lower specificity. With real-time ICD-10 benchmarking data, you can take corrective action immediately, and notice resulting improvements in claims accuracy drive more revenue capture.

Identify High-cost, Inefficient Services and Payer Networks with Performance Scoring

Payer Performance Scorecards leverages your data to evaluate your accepted payer networks, based on KPI’s such as First Pass Rate, Rejections, Cost to collect, % of Denials.

Gain control over Costly Services and Payer Networks & Leverage Data for Contract Negotiations

Review providers and high-cost services to ensure costs are consistent with expectations. Examine reimbursement efficiency & variability among payer networks. Review networks based on actual revenues versus risk-adjusted expected revenues. Increased transparency into payer network processes & revenue pathway and comparative analyses empower decision makers in contract negotiations by understanding cost-benefit value of being within each network.

Advanced Analytics for Improved Productivity

Accelerate Cash Flows with Risk Analysis

Insight into accounts receivable, denials, bad debt and payer contracts, enables you to prioritize collections efforts and streamline workflows. Use predicted “collection risk” scores to minimize the time wasted on high-risk accounts, and focus on high-value accounts with the greatest likelihood of payment. This will help improve efficiency and decrease revenues written off as bad debt or charity pay.

Point-of-Service Denials Prediction

Improve Efficiency with Point-of-Service Denials Informatics & Alerts

Insight into accounts receivable, denials, bad debt and payer contracts, enables you to prioritize collections efforts and streamline workflows. Use predicted “collection risk” scores to minimize the time wasted on high-risk accounts, and focus on high-value accounts with the greatest likelihood of payment. This will help improve efficiency and decrease revenues written off as bad debt or charity pay.

Benefits across the Enterprise

Empower users across the organization to take control of the entire revenue cycle, so you can seize every opportunity to improve profitability.

For CFO’s, Executives & Analysts

  • Gain visibility across processes affecting cash flow, net cash, bad debt, and cost-to-collect
  • Improve workflows for patient admissions, claims administration, denial management, fraud detection, and insurer contract management
  • Profile costs and revenue by facility, department, physician, diagnosis code, procedure code, etc.
  • Real-time monitoring of key revenue metrics, cost controls, daily operations across all departments to stay in constant control of bottom-line financial performance

For Billing & Administrative Staff

  • Automate planning, budgeting and forecasting tasks
  • Increase charge capture & cost capture during care delivery
  • Decrease insurance claim write-offs and bad debt
  • Reduce time & cost to collect reimbursements
  • Reduce time & cost of financial reporting (IFRS, SOX, etc.) as well as P4P and DRG tracking, reporting, and cost accounting

End-to-End Business Intelligence

Technology & Data Management Strategy

Technology Assessment
Data & Integration Strategy
Architecture Design
Data Lakes & Sandboxing

Data Integration, Cleansing & Quality

Data Integration
Data Streaming
Data Processing & Cleaning
Data Mapping
Master Data Management

Analytics & Visualization

Data Discovery
Advanced Analytics
Data Aggregation & Modeling
Reports & Dashboard Visualizations
Application & Portal Development

Our Services & Custom Engagements

No matter where in the Business Intelligence Lifecycle you are – whether just getting started or looking to take your analytics capabilities to the next level, Systech offers services across the entire spectrum. Contact us today to see what we can do for you.

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