Welcome!

Microsoft Cloud Authors: Janakiram MSV, Yeshim Deniz, David H Deans, Andreas Grabner, Stackify Blog

News Feed Item

SAI Global Compliance Launches New Compliance 360 Revenue Protection Applications for Healthcare Providers

SAI Global Compliance, the world’s leading provider of governance, risk and compliance (GRC) products, services and technology, including the Compliance 360® software suite, today announced a new application for healthcare providers, Claims Denial Manager, specifically designed to help minimize revenue loss due to pre-payment claims denials, primarily from commercial payers. Also announced are significant enhancements to its industry-leading Claims Audit Manager application, also for healthcare providers.

Amidst increasing government audits aimed at reducing erroneous billing in the Medicare and Medicaid programs, as well as increasing claims payment denials from private insurance carriers, the revenues and profits of healthcare providers face unprecedented challenges. SAI Global is providing new, advanced systems to help healthcare providers address all of these financial risks.

Today, thousands of healthcare facilities across the United States are using the Compliance 360 Claims Audit Manager to minimize revenue loss by ensuring that legitimate claims are not caught up in increasingly aggressive government audit programs. The Claims Audit Manager functions as a “Virtual Audit Coordinator,” enforcing deadlines and due dates throughout the healthcare organization and providing alerts to ensure effective management of complex appeals processes and avoidance of automatic revenue recoupment. The enhanced Claims Audit Manager increases the level of automation and includes a new underlying architecture that enables a higher degree of configuration by the customer, including the ability to customize application forms and add customer-specific data fields. The enhancements also include a variety of pre-configured reports as well as a new graphical report layout designer for easily creating custom reports.

Based on the same powerful platform and leveraging years of experience and success with the widely proven Claims Audit Manager, SAI Global is also introducing the new Claims Denial Manager application. Managing pre-payment claims denials, such as those common from commercial payers, is a significant challenge for many healthcare providers. Industry statistics indicate that healthcare providers write-off 3 to 5 percent of net revenue due to denials because they lack a comprehensive denials management program. This can equate to millions of dollars in potentially recoverable revenue for the average hospital. With most providers submitting claims to multiple payers, identifying denials, analyzing the claims to determine root causes, collecting information to support a resubmission or appeal and implementing cross-departmental process improvements is impractical without automation. The new Claims Denial Manager solution is designed to help providers manage the claims denial process with the tools needed to quickly identify and analyze denied claims, increase accountability and ultimately improve net revenue capture.

“Market acceptance of our Claims Audit Manager application has been outstanding,” said Steve McGraw, GRC president, SAI Global Compliance. “We estimate that our hospital customers have successfully appealed claims audit denials totaling $40 million in legitimate revenues with the support of our Claims Audit Manager, and substantially more is pending in active appeals. Based on this success and specific requests from our customers, we’ve developed the new Claims Denial Manager application. Used in combination with the Compliance 360 Claims Audit Manager application, healthcare providers will have the complete visibility needed to monitor and proactively manage all of their financial exposure stemming from pre-payment and post-payment claims audits and denied claims.”

According to Dr. Larry Hegland, chief medical officer for Ministry Health Care, “Payment denials from health insurance organizations are a constant challenge, creating additional pressure on the bottom line for most healthcare providers. As both sides of this equation strive to maintain revenues and margins, we expect to see increasing challenges from claims payment denials. We are glad to see that SAI Global has leveraged the experience gained with their widely deployed solution for managing RAC, MIC and other government-driven revenue audits to design and deliver this new application for managing pre-payment denials.”

The enhanced version of the Claims Audit Manager and the new Claims Denial Manager application are both generally available now from SAI Global. A broadcast demonstration of the Claims Denial Manager application is scheduled for Nov. 28, 2012, at 2:00 p.m. EST. Visit www.compliance360.com/webdemos for more details.

About Compliance 360® GRC Software Suite

The original Governance, Risk and Compliance (GRC) software solutions born in the cloud, Compliance 360 brings order and efficiency to the complexity of enterprise governance, risk management, compliance and audit management. The Compliance 360 GRC Software Suite includes regulatory compliance software, policy management software, internal audit software, incident management software, ERM software and a wide variety of specialty applications. More than 250,000 professionals every day in financial services, insurance, healthcare, distribution and other regulated industries rely on Compliance 360 applications to help protect their revenues, reputations and brands. www.compliance360.com

About SAI Global Compliance

SAI Global Compliance provides organizations with a wide range of governance, risk and compliance (GRC) products, solutions and services that help build organizational integrity and meet overall business objectives. With more than 25 years experience and offices in more than 25 countries, SAI Global’s solutions include a wide range of GRC products and services, including the Compliance 360 GRC Software Suite, best practice Code of Conduct program services and training, compliance and ethics training and awareness, risk and culture assessments, a full range of advisory services, whistleblowing hotline services, regulatory knowledge, policy management, case management and third-party compliance management, including automated due diligence workflow and management. www.saiglobal.com/compliance

More Stories By Business Wire

Copyright © 2009 Business Wire. All rights reserved. Republication or redistribution of Business Wire content is expressly prohibited without the prior written consent of Business Wire. Business Wire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

@ThingsExpo Stories
Mobile device usage has increased exponentially during the past several years, as consumers rely on handhelds for everything from news and weather to banking and purchases. What can we expect in the next few years? The way in which we interact with our devices will fundamentally change, as businesses leverage Artificial Intelligence. We already see this taking shape as businesses leverage AI for cost savings and customer responsiveness. This trend will continue, as AI is used for more sophistica...
SYS-CON Events announced today that SourceForge has been named “Media Sponsor” of SYS-CON's 21st International Cloud Expo, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. SourceForge is the largest, most trusted destination for Open Source Software development, collaboration, discovery and download on the web serving over 32 million viewers, 150 million downloads and over 460,000 active development projects each and every month.
SYS-CON Events announced today that Interface Corporation will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Interface Corporation is a company developing, manufacturing and marketing high quality and wide variety of industrial computers and interface modules such as PCIs and PCI express. For more information, visit http://www.i...
SYS-CON Events announced today that mruby Forum will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. mruby is the lightweight implementation of the Ruby language. We introduce mruby and the mruby IoT framework that enhances development productivity. For more information, visit http://forum.mruby.org/.
In his session at @ThingsExpo, Greg Gorman is the Director, IoT Developer Ecosystem, Watson IoT, will provide a short tutorial on Node-RED, a Node.js-based programming tool for wiring together hardware devices, APIs and online services in new and interesting ways. It provides a browser-based editor that makes it easy to wire together flows using a wide range of nodes in the palette that can be deployed to its runtime in a single-click. There is a large library of contributed nodes that help so...
What is the best strategy for selecting the right offshore company for your business? In his session at 21st Cloud Expo, Alan Winters, U.S. Head of Business Development at MobiDev, will discuss the things to look for - positive and negative - in evaluating your options. He will also discuss how to maximize productivity with your offshore developers. Before you start your search, clearly understand your business needs and how that impacts software choices.
SYS-CON Events announced today that Mobile Create USA will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Mobile Create USA Inc. is an MVNO-based business model that uses portable communication devices and cellular-based infrastructure in the development, sales, operation and mobile communications systems incorporating GPS capabi...
While some developers care passionately about how data centers and clouds are architected, for most, it is only the end result that matters. To the majority of companies, technology exists to solve a business problem, and only delivers value when it is solving that problem. 2017 brings the mainstream adoption of containers for production workloads. In his session at 21st Cloud Expo, Ben McCormack, VP of Operations at Evernote, will discuss how data centers of the future will be managed, how th...
There is huge complexity in implementing a successful digital business that requires efficient on-premise and cloud back-end infrastructure, IT and Internet of Things (IoT) data, analytics, Machine Learning, Artificial Intelligence (AI) and Digital Applications. In the data center alone, there are physical and virtual infrastructures, multiple operating systems, multiple applications and new and emerging business and technological paradigms such as cloud computing and XaaS. And then there are pe...
SYS-CON Events announced today that MIRAI Inc. will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. MIRAI Inc. are IT consultants from the public sector whose mission is to solve social issues by technology and innovation and to create a meaningful future for people.
SYS-CON Events announced today that Keisoku Research Consultant Co. will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Keisoku Research Consultant, Co. offers research and consulting in a wide range of civil engineering-related fields from information construction to preservation of cultural properties. For more information, vi...
SYS-CON Events announced today that Massive Networks, that helps your business operate seamlessly with fast, reliable, and secure internet and network solutions, has been named "Exhibitor" of SYS-CON's 21st International Cloud Expo ®, which will take place on Oct 31 - Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. As a premier telecommunications provider, Massive Networks is headquartered out of Louisville, Colorado. With years of experience under their belt, their team of...
SYS-CON Events announced today that Enroute Lab will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Enroute Lab is an industrial design, research and development company of unmanned robotic vehicle system. For more information, please visit http://elab.co.jp/.
SYS-CON Events announced today that Ryobi Systems will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Ryobi Systems Co., Ltd., as an information service company, specialized in business support for local governments and medical industry. We are challenging to achive the precision farming with AI. For more information, visit http:...
Real IoT production deployments running at scale are collecting sensor data from hundreds / thousands / millions of devices. The goal is to take business-critical actions on the real-time data and find insights from stored datasets. In his session at @ThingsExpo, John Walicki, Watson IoT Developer Advocate at IBM Cloud, will provide a fast-paced developer journey that follows the IoT sensor data from generation, to edge gateway, to edge analytics, to encryption, to the IBM Bluemix cloud, to Wa...
SYS-CON Events announced today that Fusic will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Fusic Co. provides mocks as virtual IoT devices. You can customize mocks, and get any amount of data at any time in your test. For more information, visit https://fusic.co.jp/english/.
SYS-CON Events announced today that B2Cloud will exhibit at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. B2Cloud specializes in IoT devices for preventive and predictive maintenance in any kind of equipment retrieving data like Energy consumption, working time, temperature, humidity, pressure, etc.
SYS-CON Events announced today that NetApp has been named “Bronze Sponsor” of SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. NetApp is the data authority for hybrid cloud. NetApp provides a full range of hybrid cloud data services that simplify management of applications and data across cloud and on-premises environments to accelerate digital transformation. Together with their partners, NetApp em...
Elon Musk is among the notable industry figures who worries about the power of AI to destroy rather than help society. Mark Zuckerberg, on the other hand, embraces all that is going on. AI is most powerful when deployed across the vast networks being built for Internets of Things in the manufacturing, transportation and logistics, retail, healthcare, government and other sectors. Is AI transforming IoT for the good or the bad? Do we need to worry about its potential destructive power? Or will we...
SYS-CON Events announced today that SIGMA Corporation will exhibit at the Japan External Trade Organization (JETRO) Pavilion at SYS-CON's 21st International Cloud Expo®, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. uLaser flow inspection device from the Japanese top share to Global Standard! Then, make the best use of data to flip to next page. For more information, visit http://www.sigma-k.co.jp/en/.