Featuring Insurance Eligibility Verification and Discovery in Dendi LIS

Effortless Data Correction to Optimize Reimbursements

Dendi is thrilled to announce its latest LIS feature: Insurance Eligibility Verification and Discovery (IEV/D). This product enhancement is a part of our commitment to driving efficiency, accuracy, and profitability for clinical labs. 

The Challenge with Current Verification Systems

In 2021, an average of 17% of claims were denied (over 48 million claims) mostly due to “incomplete or inaccurate patient information or heathcare plan changes”. Denial rates reached up to 49%for some payers. 

The healthcare industry still grapples with critical challenges when it comes to patient intake. A staggering 17% of patient intake contains errors, predominantly in patient demographics and insurance information. This number is just an unfortunate reflection of the complicated nature of the US healthcare environment and inefficient systems. 

Traditionally, RCM vendors and clearinghouses have taken on the role of verifiers. However, their scope has been limited. They might verify payer data but often miss checking for whether the coverage is active and billable. Providers rely on these services to improve their accounts receivables, but many still end up spending countless hours manually cross-checking and verifying data after receiving claims denials. By this point, it can often be too late to effectively submit appeals. The result? Lost revenue, increased overhead costs, extended claims turnaround, and reduced efficiency of operations.

Furthermore, labs find their accounts receivables affected by these inefficiencies. On average, 30% of the patient information in a healthcare provider’s database is either obsolete or incorrect. This cascading effect is evident – rejected claims, undeliverable patient statements, and, most critically, an inability to follow up with patients for both billing and clinical results.

The Benefits of Real-Time Eligibility Verification and Discovery

After consulting with various revenue cycle experts we came up with a solution designed to address these challenges head-on:

• Real-time Verification: “Insurance Eligibility Verification and Discovery” checks happen at the time of order. This ensures that any data, whether it’s insurance or demographic information, is accurate right from the start. The immediate benefit: Improved reimbursement rates.

• Decreased Overhead: No more chasing patients to rectify incorrect information. No more manual cross-checking of data. By automating and ensuring accuracy upfront, labs can significantly reduce overhead costs associated with these tedious tasks.

• Optimized Accounts Receivables: By streamlining the verification process, labs can realize a noticeable reduction in accounts receivables. This directly translates to a decrease in the cost of rework, ensuring faster payments and smoother operations.

• Focused Revenue Cycle Management (RCM): When claims rejections due to data errors are minimized, RCM vendors can channel their energies more productively. This sharpens the focus on other revenue cycle challenges, paving the way for improved overall efforts and profitability.

Powered by the Wave Analyzer

At its core, Dendi’s laboratory information system’s IEV/D feature leverages WaveHDC’s Wave Analyzer and Demographic Curator, AI-powered solutions that automatically access and compile comprehensive patient records from several sources to find the most accurate and up-to-date patient data. These solutions provide an impressive accuracy rate of over 99.9%, ensuring precise and updated patient coverage and contact information.

• Data Comparison: Upon patient intake, the data points provided are instantly compared with the records that the insurance company maintains. The Wave Analyzer then goes above and beyond by analyzing 108 points of patient data, all in real-time.
• Real-time Address Accuracy: Accurate real-time address translates into reduced returned mail and correspondence cycles and fewer claim rejections and payment delays. Ultimately, this results in faster and more predictable cash flow.
• Minimizing Security Risks: In the age of data breaches, ensuring the security of patient data is crucial. WaveHDC’s service ensures minimal HIPAA security risks by exclusively using regulated data. This commitment to security ensures that patient data remains uncompromised.

Dendi customer labs are already utilizing this transformative solution with thousands of IEV/D checks performed to date. Dendi and WaveHDC are redefining the way that healthcare providers approach eligibility verification. Their combined solution ensures that efficiency, accuracy, and profitability are at the forefront of lab operations. Contact us today to see a demo and learn more!

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