Advent Health Partners

Revolutionizing healthcare claim denials with up to 500 percent productivity lifts

Published on 17 Mar 2016

Recently, a hospital used CAVO to overturn a million-dollar claim that the insurer was refusing to pay.

Bill Butler, Vice President, Software Architecture, Advent Health Partners

Customer
Advent Health Partners

Industry
Healthcare, Insurance

Deployment country
United States

Overview

Part of the Powered Health group, Advent Health Partners (Advent) drives maximum financial returns for healthcare providers. It uses its CAVO technology to provide claims appeal services, coding corrections of denied claims—both as an outsourced service offering and as a standalone product.

Business need
Rapid changes in healthcare regulations and laborious claims processing have led to inefficiency in the US healthcare revenue cycle, with billions of dollars tied up in insurance claims denials.

Solution
Advent created CAVO, a solution built on IBM® Cloudant®, to develop smart search technology, helping analysts and clinical staff rapidly find the information needed to process denied claims appeals.

Benefits
CAVO improves the efficiency of the claims appeal process by up to 500 percent, helping providers recoup millions of dollars from erroneously denied claims for services provided.

Components

IBM products and services that were used in this case study.

Software
Cloudant Dedicated Cluster

Solution
HC: Provider Solutions, FSS: Insurance - Core Insurance - Claims, Automation, Cloud Computing, Data Warehouse, SaaS, Enabling Business Flexibility

Legal information

1 American Hospital Association: Uncompensated Hospital Care Cost Fact Sheet (http://www.aha.org/content/12/11-uncompensated-care-fact-sheet.pdf) 2 Rural hospitals, beset by financial problems, struggle to survive (https://www.washingtonpost.com/national/health-science/rural-hospitals-beset-by-financial-problems-struggle-to-survive/2015/03/15/d81af3ac-c9b2-11e4-b2a1-bed1aaea2816_story.html)

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