Astera
Case Studies
CCHP Saves $65,000 Every Year by Reducing the Need for Additional Staffing and C4K Retains over $100,000+ Every Year in Healthcare Claims Reimbursements from the Wisconsin Department of Health Services
Overview
CCHP Saves $65,000 Every Year by Reducing the Need for Additional Staffing and C4K Retains over $100,000+ Every Year in Healthcare Claims Reimbursements from the Wisconsin Department of Health ServicesAstera |
Application Infrastructure & Middleware - Data Exchange & Integration | |
Healthcare & Hospitals | |
Business Operation | |
Regulatory Compliance Monitoring | |
System Integration | |
Operational Impact
Since the process now involves little to no intervention from the data reporting team, it saves about 5 weeks’ worth of manual coding and reviewing efforts to resolve errors, which roughly translates into $26,000/year. In addition, CCHP has also saved $65,000/year in hiring an additional full-time employee for managing these EDI files. | |
Due to recurring errors in the encounters, CCHP barely met the 95% criteria of encounter data submission and approval rate for State Medicaid reimbursements. With EDIConnect in the driver’s seat to maintain data quality, the non-profit HMO has been continually reaching 97 to 98% EDI approval rates. This has led to a higher number of accepted claims that solidifies its Medicaid-certified vendor status and brings in more revenue from the state. | |
For CCHP and C4K, the real value of adding EDIConnect to its technology stack comes from the huge increase in the yearly retention of funds from accepted encounters, which is directly attributed to the improved EDI data accuracy. Now the state is paying back dollar-for-dollar for claims related to the Care4Kids program, allowing CCHP to retain over $100,000 in reimbursements. | |
Quantitative Benefit
Data submission and approval rates hitting 99% | |
Retaining over $100,000 in claim reimbursements | |
Saving $65,000 yearly in hiring additional staff for manual work. | |