Helping a Medical Lab Drop Claim Denials from 12% to 3%
AI & Automation Enablement
The Challenge
A medical lab was getting bogged down by their claims process. It was slow, manual, and complicated, which led to a high denial rate of 12% and delayed payments. The team was spending 15 hours every week just manually processing claims and chasing down denials, which was a huge drain on their time and resources.
They knew there had to be a better way, but they weren't sure how to tackle such a complex problem. They needed a solution that could not only speed up the process but also improve their accuracy and reduce their denial rate.
Pain Points
12% claim denial rate
15 hours of manual work per week
Delayed payments and cash flow issues
Complex and inefficient claims process
Lack of visibility into denial reasons
How We Helped
We used our AI & Automation Enablement service to build a predictive model that could automate most of their claims processing and flag potential issues before they led to denials.
Predictive Denial Modeling
We analyzed their historical claims data to build a predictive model that could identify claims with a high likelihood of being denied. This allowed them to fix issues proactively.
Automated Claims Submission
We built an automation that could process and submit the majority of their claims without any manual intervention, freeing up the team to focus on the more complex cases.
Denial Analysis Dashboard
We created a dashboard that gave them clear insights into why claims were being denied, so they could address the root causes and prevent future denials.
Measurable Impact
The new automated system had a massive impact on their revenue cycle and operational efficiency.
Better Financials
Reducing the denial rate from 12% to 3% had a direct, positive impact on their cash flow and bottom line.
Smoother Operations
Automating 80% of their claims processing saved the team 15 hours of manual work every week, allowing them to focus on more strategic tasks.
A Stronger Position
With a much more efficient and accurate claims process, they were able to improve their relationships with payers and strengthen their financial stability.
Additional Key Outcomes
A clear, data-driven understanding of denial reasons
A significant reduction in manual, repetitive work
Faster payment cycles and improved cash flow
A scalable system that can handle growing claim volumes
Strategic Value
This project was about more than just speeding up a process. By using AI to predict and prevent denials, we helped them turn their revenue cycle from a reactive, manual chore into a proactive, strategic advantage. They're now in a much stronger financial position and can focus on growing their business.
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Think We Could Help Your Lab?
If you're struggling with manual processes or high denial rates, we'd be happy to chat. See how our AI & Automation Enablement service can help you streamline your revenue cycle and improve your bottom line.
Automate manual and repetitive tasks
Reduce claim denials and improve cash flow
Gain insights into your revenue cycle performance
Free up your team for higher-value work