Solutions for Performance in Claims Management

Technology and Target Operating Model Focus Though a Process Specific Approach:

 

Revenue Optimized
VWi Experience

Starting with a baseline Target Operating Model for Denial & Rejection Mitigation, our solution comprises a full range of root-cause analysis and payor insights processes that represent industry leading

efficiencies.

 

Related to specific processes, VWi key pronouncements are standardization, streamlining and automation, which is measured and analyzed based on the payor portfolio.

  • Targeted management of payor denials increase overall collections and avoids payment delays.

  • Detailed denial management analysis quickly identifies accurate, actionable information.

  • Our teams focus on high-return priorities to maximize client outcomes.

  • Process feedback provides VWi clients with insights to prevent future denials.

Claims Process

Health insurance claims that are denied, pending, delayed, challenged or underpaid require time-consuming and detailed attention. Carving out dedicated resources to follow up on problem payors and denials can be a challenge for many healthcare providers.

 

 

Our solutions maximize revenue opportunities by monitoring timely filing guidelines, claims adjudication, identifying the root cause of the denial and responding via appeals.

 

Furthering the mitigating need for providers to dedicate resources, the VWi solution reduces effort-heavy and highly technical claims processing. We deliver additional value through:

 

  • Flexible programs are built around both clinical and technical denials

  • VWi Experts are available to supplement existing in-house denials staff or take over entire denials program.

  • Specialists are available to handle Level 1, Level 2 and Level 3 appeals administrative hearings on behalf of providers.

Growth through Leadership, Innovation, and People who deliver results. Our Mission: with you, we create and deliver business and technology solutions that fit your needs and drive the results you want.

Delivering Experts Dedicated to Your Engagement
Process Re-Engineering

Tracking the revenue and resource time engaged when managing denials give valuable insight to key leadership in a quantifiable form to change denial management focus where the return on investment can be maximized.

 

Insight into denial root cause brings forward the detail needed to effectively re-engineer workflows and retrain staff, physicians, and providers. Coding, additional documentation, registrations, necessity, authorizations and other root cause mitigation strategies are implemented.

VWi Additional  Value

 

  • Insights and Analytics in a comprehensive, customizable reporting package to identify trends

  • Governance structure provided by domain experts

  • Collaborative Process Re-Engineering mitigates repetitive denials for the same procedure from the same payor

  • Education by engaging provider staff in claim denials management improvement to prevent future denials