Reducing Payer Denials with Custom Workflows That Drive Results
Testimonial
Biodesix needed a customized insurance follow up process that allowed them to clearly view what was going on between their payers and the claims.
Challenge
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.
Client Goal: A customized approach for insurance follow-up to improve processes and reduce denials.
Healthy Collaboration
Biodesix partnered with Quadax in 2011 to outsource its billing processes. Quadax was chosen as the Revenue Cycle Management 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 their 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.”
Fewer Denials
Increased visibility and predictability increased rate of successful claims
Greater Efficiency
Defined workflows reduced time spent on insurance follow-up
“We were able to identify one particular denial and fix the issue, which reduced the number of denied claims by 3.5% – meaning we eliminated the need for those claims to be reworked.”
