How we do it
With a thriving partnership started in Workers’ Compensation accounts receivable (A/R), the client increasingly called upon HGS to deliver tasks that positively impacted bottom-line savings and efficiencies. A great example of this work has been meeting the client’s significant challenges with collecting outstanding claims from payers. The client knew of HGS’s success deploying analytics-as-a-service propensity models to drive end-to-end lifecycle efficiencies, for providers and payers alike. HGS conducted a deep dive of the client’s challenges to develop a model that presented insights about propensity to pay for claims, targeting a better work process, payer focus, and faster turnaround time.
HGS’s predictive model estimated and ranked payment collection likelihood by claim and payer, aiming to:
- Improve the rate of collection by guided focus based on claim attributes.
- Save effort and time spent on the overall collection process.
- Increase the amount collected and speed of recovery by prioritizing high-value and high-propensity claims.
HGS extracted multiple features from various sources/tables to create the predictive model. Model features addressed claims characteristics such as patient demographics and payer detail, service providers within the hospital, payer payment and transaction detail, claim duration, and follow-up duration, and detailed denial information from HIPAA 835 files.