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Claim Sense

Healthcare Payor's Claim Process Transformation

Enhance your healthcare claims processing with Claim Sense by Ennuviz. Achieve a 30% cost reduction, 40% faster turnaround, and a 35% increase in auto-adjudication rates. Streamline operations and boost efficiency with our advanced solution.

Healthcare Payor's Claim Process Transformation

Challenges

Healthcare payers are facing two major challenges in the current healthcare landscape. They need to ensure operational efficiency and lower the claims processing cost in a rapidly changing industry. About 20-30% of claims require manual handling, leading to "pending" statuses and additional fees. Furthermore, processing low-value claims is often more expensive than their actual value, which makes it difficult to decide whether to automate, auto-adjudicate, or handle them manually.

Per Claim Processing Cost
Per Claim Processing Cost
>$30
Average Claim Processing Time
Average Claim Processing Time
30 Days
First-pass Claim Acceptance Rate
First-pass Claim Acceptance Rate
80%
Average Claim Backlog
Average Claim Backlog
25%
Claims Auto-adjudication Rate
Claims Auto-adjudication Rate
60%
Claim Denial Rate
Claim Denial Rate
15%

claim management

Our Solution

Claim Sense revolutionizes Healthcare Payors' Claims Operations, enabling swift resolution of pending codes through deep insights into their dependencies. This approach cuts claim iterations by half and significantly reduces the overall claim cycle time, leading to substantial cost savings. Result? A notable 12% decrease in operational expenses, a 40% faster throughput, and a double ROI within three years. Moreover, Claim Sense achieves a 40% auto-approval rate for low-value claims, elevating claim operations to unprecedented levels of efficiency and effectiveness

Source Systems Supported

Payors claim operations
Uncover Pend Dependency
Utilizing Process Mining technology, our solution sifts through historical claim data, pend codes, and resolution steps to identify specific pend codes and resolution steps tailored to each claim type and characteristic. This analysis provides Claims Operations with actionable insights and instructions, aiming to expedite claim adjudication
Healthcare claim management
Low Value Claim Handling
Optimizes the cost of processing low-value claims by providing insights to decision-making on whether to auto-adjudicate or automate to reducing reliance on manual processes, and ensuring a more efficient claims management system. Through this innovative approach, Payor’s can achieve significant operational cost savings and enhance their auto-adjudication rates, ultimately leading to a more efficient and responsive claims processing environment​​.

Features

Benefits

Cost Saved
30%
Reduce Turnaround Time
40%
Increase Auto-Adjudication Rate
35%
Increased First-Pass Rate
45%

Here’s how to Get Started

Effortlessly unlock business success by connecting with a dedicated Advisor, receiving a personalized Technology Roadmap, and focusing on business growth with your technology needs in capable hands.

30 Days Free.

Our experts will guide you and uncover actionable process improvement opportunities by seamlessly integrating with your source systems in the trial instance.

Business Review.

We offer solution walk-throughs and process improvement insights, enabling you to evaluate and validate improvements, ensuring measurable return on investment. Experience impactful results tailored to your business needs.

Grow Your Business.

Now that you have validated the solution and business benefits, you can focus on running your business and staying ahead of the competition.

Why Ennuviz?

50+ Years of Technology Expertise

Our wealth of experience has equipped us with the proficiency to deliver exceptional services to you.

10K Processes Modeled

We have effectively assisted organizations in delivering 10K+ Process Models to improve Adoptions and Productivity.

50+ Certified Consultants

Our team, with extensive knowledge, provides the best service and support to meet your needs.

1000+ Tasks Automated

We have successfully automated processes with enormous results benefiting the organization.

15+ Versatile Connectors

You aren’t limited to connecting only your SAP systems; our connectors allow you to connect to most enterprise source systems.

50+ Prebuilt Transformations

Our Prebuilt Transformations deliver Clear visibility over your process, covering your array of enterprise source systems. Not just SAP.

100+ Process Mining Apps

Our Process Mining Apps support SAP and non-SAP source Systems and cover a wide variety of use cases. They are simple to install and ready to optimize.

Migration

Migrate your existing Process Mining solution from tools like Celonis to SAP Signavio Process Intelligence, saving 70% migration effort.

Let's get started today

Because we put you first. Our customer-obsessed working model honors client's needs.

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