Avoidable Claims Denials and the Road to Payer/Provider Collaboration — ICYMI

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The estimated annual administrative cost of health care has eclipsed $1.1 trillion, according to a report from Optum. Recent studies peg nearly 25 percent of these costs as coming from clinical and administrative waste due to a lack of transparency between payers and providers which results in improper denials.

Medicaid in particular experiences a higher percentage of initial claims denials — 25 percent, as opposed to 7.3 percent for Medicare and 4.8 percent for commercial providers — and the percentage of provider revenue loss due to denials is also higher for Medicaid providers (17.4 percent) than Medicare (5 percent) or commercial providers (2.8 percent). There is a direct, causal link between claim denial rates and Medicaid provider enrollment.

John Campbell, former director of Medicaid enterprise systems for the Utah Department of Technology Services and now director of product management for Optum State Government Solutions, joins Dustin and Joe on this episode of ICYMI to discuss the ongoing challenges for state governments and providers in managing avoidable claims denials. Campbell also provides examples of how technology is being leveraged to modernize the claims process and recommends ways the public sector can address the issue as a priority.

LEARN MORE

• Visit Optum to learn more about their solution
• Connect with John Campbell on LinkedIn

COMING SOON

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