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Claims and Denials Management 2017 Claims and Denials Management 2017
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Claims and Denials Management 2017
Support & New Tools Highly Valued in Well-Established Market

author - Paul Pitcher
Paul Pitcher
author - Lois Krotz
Lois Krotz
November 14, 2017 | Read Time: 3  minutes

With strong, easy-to-use claims-editing functionality now a commodity among claims management solutions, what differentiates the vendors in this market, and what areas do healthcare organizations identify as being next on their wish lists? Interviews with 296 healthcare organizations reveal three key factors that organizations are looking for from their claims management vendor today: stellar support, improved denials management functionality, and better drill-down analytics. The first two are examined below.

1. Exceptional Service and Functionality Drive Top Performance by Lesser-Known Quadax

Not known widely to the market, performance leader Quadax was previously found primarily in the Midwest but now has customers of all sizes in the South and East as well. Quadax’s top performance score is driven largely by exceptional service and product functionality. Their support personnel are both responsive and effective in resolving issues, and a few customers note that Quadax is willing to accommodate requests for customization. With workflows multiple users describe as smooth, the Quadax solution is easy to use and easy to train people on. Several customers report that Quadax delivers robust functionality that supports optimal workflows.

overallperformance scores

2. Behind Quadax, Vendors SSI Group, Experian Health, and Change Healthcare (RelayAssurance) Deliver Quality Relationships That Lead to High Satisfaction

Quick and responsive, SSI Group’s support personnel are easy to work with, and several customers recounted experiences in which SSI Group provided additional help without charging extra. Experian Health’s support is also responsive and provides same-day resolution for urgent issues; customers can access technical expertise directly when needed. Support personnel for RelayAssurance, the better performing of Change Healthcare’s two products, resolve urgent issues in 24 hours and nonurgent issues in 48 hours. Account managers foster proactive relationships, which clients hope won’t be disrupted by the new Change Healthcare company formed through the McKesson/RelayHealth merger. Some clients of Change Healthcare’s other product, Claims and Denials Advisor, as well as some nThrive customers have experienced support disruptions due to recent acquisition and merger activity. While many still receive high-quality support, others experience communication breakdowns and have trouble getting tickets resolved in a timely manner.

relationships driving performance

3. Organizations Hesitant to Adopt Denials Management from Their Claims Vendor; Epic Emerges as Surprisingly Common DM Player for Users of Epic RCM

number of validated customers using denialsmanagement product

Few organizations feel vendors’ denials management functionality is robust enough to meet workflow needs today. Only 35 of the 117 organizations interviewed about denials management use their claims vendor to also manage denials; the rest use another vendor or do not report using any commercially available product. Surprisingly, Epic is the vendor named most frequently as being used. One-third of the 35 interviewed Epic RCM customers mentioned using Epic Resolute to manage denials. Several described the tool as robust and use it to examine claims, remittance, patient accounting, and EMR data to pinpoint why claims are denied. No other revenue cycle solutions were brought up prevalently as being used to manage denials. All claims vendors in this report have customers who mentioned using them for denials management, but only ZirMed, Quadax, and nThrive had 6 or more do so. Several ZirMed customers described the denials module as difficult to use or lacking needed functionality, such as more robust denials tracking and reporting. The few customers using Quadax’s module find it to be a worthwhile add-on that makes editing denials easy.

Vendor Bottom Lines

vendor bottom lines
author - Elizabeth Pew
Elizabeth Pew
author - Jess Wallace-Simpson
Jess Wallace-Simpson
author - Robert Ellis
Project Manager
Robert Ellis
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.

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