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Points of Light 2023 Case Study 1 Points of Light 2023 Case Study 1
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Points of Light 2023 Case Study 1
Simplifying the Administrative Process through Shared Clinical Data

author - Boyd Stewart
Author
Boyd Stewart
author - Aurene Wilford
Author
Aurene Wilford
 
April 12, 2023 | Read Time: 1  minute

Seeking to ease the administrative burden created for both sides by manual denial and prior authorization processes, the collaborators in this case study first identified common pain points and then established shared goals. One of their initial projects was to reduce the need for Payer Organization 1’s clinicians to request additional information from Healthcare Organization 1 during claims review. To accomplish this, they utilized the Clinical Document Exchange within Epic Payer Platform to give the clinicians in-workflow access to members’ clinical data. The results have been improved efficiency, a significant reduction in denials, and a more trusting relationship.

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Key Findings:

  1. Executive Summary
  2. The Collaborators
  3. Points of Friction—Challenges to Be Solved
  4. Action Plan—How the Collaborators Worked Together to Reduce Friction
  5. Points of Light—Outcomes Achieved through Collaboration
  6. Lessons Learned—What Best Practices Can Other Organizations Replicate?
  7. What's Next?—Vision for the Future
author - Elizabeth Pew
Writer
Elizabeth Pew
author - Jess Wallace-Simpson
Designer
Jess Wallace-Simpson
author - Joel Sanchez
Project Manager
Joel Sanchez
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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.