More Case Studies
Data Driven Cost Recovery
Coordinated Care Plan Masters its Data
Our client operates an innovative model of coordinated healthcare for dual-eligibles—people who qualify for both Medicare and Medicaid. Currently operating in two states, it ranks among the fastest-growing private companies in the U.S.
A spike in claims expense prompted company leadership to seek audit assistance to better understand their benefit spend. In essence, our client needed data warehouse capabilities without the wait or expense required to create one of their own.
The first step in accessing the power of this organization’s data was to aggregate claims information existing in three different systems, being processed by three separate organizations and align expenses by member through incorporation of enrollment detail. All files were exchanged and ePHI masked utilizing HIPAA compliant methodologies. The second stage involved working with the company’s subject matter experts to tag the data in a variety of ways to enable targeted analysis to occur. The organization had identified a series of business decisions and benefit limitations which they wanted to better understand.
Analysis provided specific cost associated with business decisions which enabled leadership to make informed alterations to those policies. Benefit leakage associated with claim activity falling within contractually arranged per diems was identified and actions initiated to collect inappropriate payments. Blue Slate was asked to identify and quantify other various categories of claims to help resolve error patterns and prevent further leakage.