Welcome!

Microsoft Cloud Authors: Liz McMillan, Elizabeth White, Mihai Corbuleac, Pat Romanski, David Bermingham

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
SYS-CON Events announced today that 24Notion has been named “Bronze Sponsor” of SYS-CON's 18th Cloud Expo, which will take place on June 7-9, 2016, at the Javits Center in New York, New York. 24Notion is full-service global creative digital marketing, technology and lifestyle agency that combines strategic ideas with customized tactical execution. With a broad understand of the art of traditional marketing, new media, communications and social influence, 24Notion uniquely understands how to con...
The essence of data analysis involves setting up data pipelines that consist of several operations that are chained together – starting from data collection, data quality checks, data integration, data analysis and data visualization (including the setting up of interaction paths in that visualization). In our opinion, the challenges stem from the technology diversity at each stage of the data pipeline as well as the lack of process around the analysis.
The demand for organizations to expand their infrastructure to multiple IT environments like the cloud, on-premise, mobile, bring your own device (BYOD) and the Internet of Things (IoT) continues to grow. As this hybrid infrastructure increases, the challenge to monitor the security of these systems increases in volume and complexity. In his session at 18th Cloud Expo, Stephen Coty, Chief Security Evangelist at Alert Logic, will show how properly configured and managed security architecture can...
What a difference a year makes. Organizations aren’t just talking about IoT possibilities, it is now baked into their core business strategy. With IoT, billions of devices generating data from different companies on different networks around the globe need to interact. From efficiency to better customer insights to completely new business models, IoT will turn traditional business models upside down. In the new customer-centric age, the key to success is delivering critical services and apps wit...
When it comes to IoT in the enterprise, namely the commercial building and hospitality markets, a benefit not getting the attention it deserves is energy efficiency, and IoT's direct impact on a cleaner, greener environment when installed in smart buildings. Until now clean technology was offered piecemeal and led with point solutions that require significant systems integration to orchestrate and deploy. There didn't exist a 'top down' approach that can manage and monitor the way a Smart Buildi...
SYS-CON Events announced today BZ Media LLC has been named “Media Sponsor” of SYS-CON's 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. BZ Media LLC is a high-tech media company that produces technical conferences and expositions, and publishes a magazine, newsletters and websites in the software development, SharePoint, mobile development and Commercial Drone markets.
WebRTC is bringing significant change to the communications landscape that will bridge the worlds of web and telephony, making the Internet the new standard for communications. Cloud9 took the road less traveled and used WebRTC to create a downloadable enterprise-grade communications platform that is changing the communication dynamic in the financial sector. In his session at @ThingsExpo, Leo Papadopoulos, CTO of Cloud9, will discuss the importance of WebRTC and how it enables companies to fo...
SYS-CON Events announced today TechTarget has been named “Media Sponsor” of SYS-CON's 18th International Cloud Expo, which will take place on June 7–9, 2016, at the Javits Center in New York City, NY, and the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. TechTarget is the Web’s leading destination for serious technology buyers researching and making enterprise technology decisions. Its extensive global networ...
With major technology companies and startups seriously embracing IoT strategies, now is the perfect time to attend @ThingsExpo 2016 in New York and Silicon Valley. Learn what is going on, contribute to the discussions, and ensure that your enterprise is as "IoT-Ready" as it can be! Internet of @ThingsExpo, taking place Nov 3-5, 2015, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with 17th Cloud Expo and will feature technical sessions from a rock star conference faculty ...
The 19th International Cloud Expo has announced that its Call for Papers is open. Cloud Expo, to be held November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA, brings together Cloud Computing, Big Data, Internet of Things, DevOps, Containers, Microservices and WebRTC to one location. With cloud computing driving a higher percentage of enterprise IT budgets every year, it becomes increasingly important to plant your flag in this fast-expanding business opportunity. Submit y...
Internet of @ThingsExpo, taking place November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with the 19th International Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world and ThingsExpo New York Call for Papers is now open.
SYS-CON Events announced today that ContentMX, the marketing technology and services company with a singular mission to increase engagement and drive more conversations for enterprise, channel and SMB technology marketers, has been named “Sponsor & Exhibitor Lounge Sponsor” of SYS-CON's 18th Cloud Expo, which will take place on June 7-9, 2016, at the Javits Center in New York City, New York. “CloudExpo is a great opportunity to start a conversation with new prospects, but what happens after the...
In his keynote at 18th Cloud Expo, Andrew Keys, Co-Founder of ConsenSys Enterprise, will provide an overview of the evolution of the Internet and the Database and the future of their combination – the Blockchain. Andrew Keys is Co-Founder of ConsenSys Enterprise. He comes to ConsenSys Enterprise with capital markets, technology and entrepreneurial experience. Previously, he worked for UBS investment bank in equities analysis. Later, he was responsible for the creation and distribution of life ...
There are several IoTs: the Industrial Internet, Consumer Wearables, Wearables and Healthcare, Supply Chains, and the movement toward Smart Grids, Cities, Regions, and Nations. There are competing communications standards every step of the way, a bewildering array of sensors and devices, and an entire world of competing data analytics platforms. To some this appears to be chaos. In this power panel at @ThingsExpo, moderated by Conference Chair Roger Strukhoff, panelists will discuss the vast to...
SYS-CON Events announced today that Enzu, a leading provider of cloud hosting solutions, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Enzu’s mission is to be the leading provider of enterprise cloud solutions worldwide. Enzu enables online businesses to use its IT infrastructure to their competitive advantage. By offering a suite of proven hosting and management services, Enzu wants companies to foc...
Customer experience has become a competitive differentiator for companies, and it’s imperative that brands seamlessly connect the customer journey across all platforms. With the continued explosion of IoT, join us for a look at how to build a winning digital foundation in the connected era – today and in the future. In his session at @ThingsExpo, Chris Nguyen, Group Product Marketing Manager at Adobe, will discuss how to successfully leverage mobile, rapidly deploy content, capture real-time d...
A strange thing is happening along the way to the Internet of Things, namely far too many devices to work with and manage. It has become clear that we'll need much higher efficiency user experiences that can allow us to more easily and scalably work with the thousands of devices that will soon be in each of our lives. Enter the conversational interface revolution, combining bots we can literally talk with, gesture to, and even direct with our thoughts, with embedded artificial intelligence, wh...
IoT generates lots of temporal data. But how do you unlock its value? How do you coordinate the diverse moving parts that must come together when developing your IoT product? What are the key challenges addressed by Data as a Service? How does cloud computing underlie and connect the notions of Digital and DevOps What is the impact of the API economy? What is the business imperative for Cognitive Computing? Get all these questions and hundreds more like them answered at the 18th Cloud Expo...
Whether your IoT service is connecting cars, homes, appliances, wearable, cameras or other devices, one question hangs in the balance – how do you actually make money from this service? The ability to turn your IoT service into profit requires the ability to create a monetization strategy that is flexible, scalable and working for you in real-time. It must be a transparent, smoothly implemented strategy that all stakeholders – from customers to the board – will be able to understand and comprehe...
Korean Broadcasting System (KBS) will feature the upcoming 18th Cloud Expo | @ThingsExpo in a New York news documentary about the "New IT for the Future." The documentary will cover how big companies are transmitting or adopting the new IT for the future and will be filmed on the expo floor between June 7-June 9, 2016, at the Javits Center in New York City, New York. KBS has long been a leader in the development of the broadcasting culture of Korea. As the key public service broadcaster of Korea...