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Decision Insights™ Claims Management & Clearinghouse Commentary

Subject Expert
Dustin Cragun
VP of Revenue Cycle Research
KLAS VP of Revenue Cycle Research - Dustin Cragun
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Related ReportsView All Reports
Point of Light
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Points of Light 2023 Case Study 6
13 April 23    |   Aurene Wilford and Boyd Stewart
To reduce the manual work associated with claims monitoring, the partners in this case study collaborated to combine API technology from the payer with robotic process automation (RPA) technology from Waystar. Claims statuses are then normalized and delivered directly into the healthcare organization’s EMR workflows, resulting in greater claims visibility and a reduced administrative burden for all parties. As a result of this collaboration, the healthcare organization has also seen reduced denials and faster payment collection.
Decision Insights
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Claims Management 2023
25 January 23    |   Dustin Cragun and Jaren Day
The financial well-being of healthcare organizations is critical, especially given the macroeconomic pressures they face today. Many are looking at claims management and clearinghouse technology to maximize cash collections and reduce administrative burdens. To better understand what factors are influencing purchase decisions and which vendors are seen as capable of driving success, this report examines 24 recent purchase decisions validated by KLAS between February 2020 and November 2022. For additional context, satisfaction data from current customers is also included. It should be noted that the decisions in this report are not a comprehensive representation of all claims management purchase decisions made in the last several years.
Perception
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Optum/Change Healthcare Merger
16 August 22    |   Boyd Stewart and Sam Eaquinto
In January 2021, Optum announced their intentions to acquire Change Healthcare. The merger remains unfinalized, however, as the US Department of Justice blocked the deal in February 2022 due to anticompetition concerns—such a merger would give UnitedHealth Group, Optum’s parent company and the nation’s largest insurer, access to rivals’ sensitive data. The legal proceeding is ongoing and scheduled to go to trial August 1, 2022. This report shares Optum and Change Healthcare customers’ reactions to the merger and their perceptions of its impact. Between March 2021 and April 2022, KLAS interviewed 48 individuals from 46 unique organizations; of these respondents, 9% are Optum customers, 56% are Change Healthcare customers, and 35% are customers of both vendors.


Subject Expert
Dustin Cragun
VP of Revenue Cycle Research
KLAS VP of Revenue Cycle Research - Dustin Cragun



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