Saving Time on Claims Statusing

Our ongoing partnership with Tegria allowed us to solve the problem quickly without taking away from our high-priority work. We benefit greatly from their expertise and consider them part of the team!

SANDRA JONESSr. Director, Novant Health

Background and Challenge

Novant Health wanted to streamline claims management to align with its belief that healthcare doesn’t have to be confusing, difficult, or disconnected. This presented a significant challenge, as Novant Health processes claims across multiple provider and payer systems with more than 640 locations spanning four states.   

Novant Health team members were unnecessarily spending time manually researching “no response follow-ups,” or claims awaiting a payer response. Often, no action was needed, but staff members couldn’t see this without working through each step of the follow-up process. This resulted in between three to 30 minutes of unnecessary follow-up time for each claim.    

Solution

Tegria’s experienced analysts worked with Novant Health’s revenue cycle leaders to design a solution to streamline claims statusing and prevent unneeded follow-up. To allow internal teams to stay focused on vital day-to-day operations, the Tegria team took on the analytical groundwork, reviewing historical work queues and assessing claim inflow and outflow. These insights helped the team develop routing and timing logic to hold claims until they needed to be worked—allowing staff to prioritize those claims that truly needed to be worked right away.  

The solution enabled the system to automatically defer certain claims and incorporate claims status information into the clearinghouse.