Reduction in Claims Denials
Sohar reduces front-end RCM errors to prevent denials before they happen.
Results
Claims denials are a significant cost burden for healthcare providers, and more than 85% are associated with front-end RCM errors. Sohar tackles this challenge by identifying payer carve-outs, ensuring accurate member ID details, and preemptively addressing claim-related issues.
Products and features designed for reducing claims denials.
Discovery
Proactively identifies active insurance for patients, using simply their first name, last name, date of birth, and state.
Verification
Real-time eligibility checks ensure patients’ coverage is validated accurately and in a timely manner.
Network Status
Clarifies in-network vs. out-of-network status to set accurate patient expectations and reduce financial risk of denied claims.
Pain Points
- High denial rates due to undetected carve-outs
- Errors in member ID routing leading to claims rejections
- Excessive administrative costs for resubmissions
Key Metrics
- Substantial reduction in claim denials
- Meaningful improvement in time to collection
- Decrease in administrative rework
Talkiatry faced frequent denials related to carve-outs and member ID mismatches. By integrating Sohar’s carve-out identification and member ID validation features, they achieved a measurable reduction in denials, improving overall claim acceptance rates and reducing administrative costs.
Get started with Sohar.
Claims denials create an unnecessary administrative and financial burden on providers. Sohar’s accuracy-driven APIs offer proactive solutions to tackle claim denials at their root, ensuring that healthcare providers save time, reduce claim write-offs, and improve their revenue cycle outcomes.
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FAQ
Sohar uses advanced mapping to flag behavioral health carve-outs and support proper routing of claim submissions.
On occasion, patients may provide inaccurate information. Despite this, Sohar uses a combination of payer intelligence and tens of thousands of routing rules to ensure that the patient’s benefits can be found. Sohar also provides the correct data on file for a patient which can be passed on to a medical biller, to ensure that a clean claim is submitted.
Yes, Sohar identifies carve-outs and applies payer-specific workflows to resolve them. The detection rate for Magellan and Carelon is over 90%.
Automated processes minimize manual interventions for denied claims, saving significant time and resources, up to 960 hours per RCM FTE per year.