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
Advent Health Partners
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.
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.
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.
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.
IBM products and services that were used in this case study.
Cloudant Dedicated Cluster
HC: Provider Solutions, FSS: Insurance - Core Insurance - Claims, Automation, Cloud Computing, Data Warehouse, SaaS, Enabling Business Flexibility
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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)