Delivering on the promise of making things better: Enabling insight-led enterprise change in healthcare
Summary
The claims’ management process is a known area of inefficiency and a major headache, both for healthcare providers and patients – a perfect place to prove the value of insight-led operations. Upon discharge, patients are at their most vulnerable, and receiving a large unexpected bill leaves a very sour taste – especially as hospital stays require pre-authorisation, so you assume you’ll be covered. These rejected and short-paid claims account for up to 30% of all billing and take up to 10 times as long to resolve, resulting in hundreds of wasted hours and millions of Rands in lost revenue. Working with a leading South African healthcare provider, BSG built a predictive model using machine learning to identify claims with a high likelihood of rejection. This helped it to understand reasons for rejection, enabling proactive management of cases.