“We needed a customized insurance follow up process that allowed us to clearly view what was going on between
our payers and the claims.” –Director of Customer Operations, Biodesix
CASE STUDY
CLIENT: Biodesix (Boulder, CO)
CLIENT INFORMATION: Biodesix is a leading diagnostic solutions company focused on improving clinical care and patient outcomes. Guided by its mission to transform patient care through personalized diagnostics, the company provides advanced diagnostic testing and custom development services that support more informed clinical decision-making and improved healthcare outcomes.
CHALLENGE: Gain control over payer documentation and denials.
For its lab tests, Biodesix found that payers often required validation in the form of prior authorization, medical records and more–but often after the claim had been submitted. Because of the variety of different denial codes–all with different meanings and requirements across payers – each response had to be customized to prevent administrative denials.
Biodesix sought a better way to anticipate requests and organize their handling in a way that made it easier to take action and would allow for timely tracking and resolution of claim denials.
GOAL: A customized approach for insurance follow-up to improve processes and reduce denials.
SOLUTION: A custom payer database and workflow integrations.
Biodesix partnered with Quadax in 2011 to outsource its billing processes. Quadax was chosen as the Revenue Cycle Management (RCM) vendor for many aspects of its claims management, reimbursement management, denials and appeals management, payer contract management and patient access solutions.
Working collaboratively, Quadax developed a custom database specific to Biodesix, utilizing payer information from over 800 payers and designing workflows specific to their needs.
A Prescription of Manageability
Quadax applied Biodesix’s desired workflow specifications to design a customized insurance follow up workflow that routed by payer groupings. Workflow was organized based on no response from the payer, allowing any claims that had not been adjudicated to be added to a worklist for follow up, as well as by the ANSI response from the payer. Having that ability and specific worklists allowed Biodesix to sort denials by payer and further sort those denials at the individual worklist level.
According to Biodesix’s Director of Customer Operations, “By outsourcing our billing to Quadax, we were able to focus on our clinical mission – helping providers offer a personalized approach to cancer care for patients facing lung cancer.”