|By Business Wire||
|November 5, 2012 11:16 AM EST||
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
@ThingsExpo has been named the Top 5 Most Influential M2M Brand by Onalytica in the ‘Machine to Machine: Top 100 Influencers and Brands.' Onalytica analyzed the online debate on M2M by looking at over 85,000 tweets to provide the most influential individuals and brands that drive the discussion. According to Onalytica the "analysis showed a very engaged community with a lot of interactive tweets. The M2M discussion seems to be more fragmented and driven by some of the major brands present in the...
Oct. 25, 2016 06:15 AM EDT Reads: 11,421
We are reaching the end of the beginning with WebRTC, and real systems using this technology have begun to appear. One challenge that faces every WebRTC deployment (in some form or another) is identity management. For example, if you have an existing service – possibly built on a variety of different PaaS/SaaS offerings – and you want to add real-time communications you are faced with a challenge relating to user management, authentication, authorization, and validation. Service providers will w...
Oct. 25, 2016 05:30 AM EDT Reads: 3,368
DevOps is being widely accepted (if not fully adopted) as essential in enterprise IT. But as Enterprise DevOps gains maturity, expands scope, and increases velocity, the need for data-driven decisions across teams becomes more acute. DevOps teams in any modern business must wrangle the ‘digital exhaust’ from the delivery toolchain, "pervasive" and "cognitive" computing, APIs and services, mobile devices and applications, the Internet of Things, and now even blockchain. In this power panel at @...
Oct. 25, 2016 05:15 AM EDT Reads: 1,992
SYS-CON Media announced today that @WebRTCSummit Blog, the largest WebRTC resource in the world, has been launched. @WebRTCSummit Blog offers top articles, news stories, and blog posts from the world's well-known experts and guarantees better exposure for its authors than any other publication. @WebRTCSummit Blog can be bookmarked ▸ Here @WebRTCSummit conference site can be bookmarked ▸ Here
Oct. 25, 2016 04:30 AM EDT Reads: 9,701
SYS-CON Events announced today that Streamlyzer will exhibit at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. Streamlyzer is a powerful analytics for video streaming service that enables video streaming providers to monitor and analyze QoE (Quality-of-Experience) from end-user devices in real time.
Oct. 25, 2016 04:15 AM EDT Reads: 1,008
You have great SaaS business app ideas. You want to turn your idea quickly into a functional and engaging proof of concept. You need to be able to modify it to meet customers' needs, and you need to deliver a complete and secure SaaS application. How could you achieve all the above and yet avoid unforeseen IT requirements that add unnecessary cost and complexity? You also want your app to be responsive in any device at any time. In his session at 19th Cloud Expo, Mark Allen, General Manager of...
Oct. 25, 2016 04:15 AM EDT Reads: 947
One of biggest questions about Big Data is “How do we harness all that information for business use quickly and effectively?” Geographic Information Systems (GIS) or spatial technology is about more than making maps, but adding critical context and meaning to data of all types, coming from all different channels – even sensors. In his session at @ThingsExpo, William (Bill) Meehan, director of utility solutions for Esri, will take a closer look at the current state of spatial technology and ar...
Oct. 25, 2016 04:15 AM EDT Reads: 1,738
SYS-CON Events announced today that SoftNet Solutions will exhibit at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. SoftNet Solutions specializes in Enterprise Solutions for Hadoop and Big Data. It offers customers the most open, robust, and value-conscious portfolio of solutions, services, and tools for the shortest route to success with Big Data. The unique differentiator is the ability to architect and ...
Oct. 25, 2016 04:00 AM EDT Reads: 962
The IoT industry is now at a crossroads, between the fast-paced innovation of technologies and the pending mass adoption by global enterprises. The complexity of combining rapidly evolving technologies and the need to establish practices for market acceleration pose a strong challenge to global enterprises as well as IoT vendors. In his session at @ThingsExpo, Clark Smith, senior product manager for Numerex, will discuss how Numerex, as an experienced, established IoT provider, has embraced a ...
Oct. 25, 2016 03:45 AM EDT Reads: 1,123
Cloud based infrastructure deployment is becoming more and more appealing to customers, from Fortune 500 companies to SMEs due to its pay-as-you-go model. Enterprise storage vendors are able to reach out to these customers by integrating in cloud based deployments; this needs adaptability and interoperability of the products confirming to cloud standards such as OpenStack, CloudStack, or Azure. As compared to off the shelf commodity storage, enterprise storages by its reliability, high-availabil...
Oct. 25, 2016 03:15 AM EDT Reads: 1,154
Donna Yasay, President of HomeGrid Forum, today discussed with a panel of technology peers how certification programs are at the forefront of interoperability, and the answer for vendors looking to keep up with today's growing industry for smart home innovation. "To ensure multi-vendor interoperability, accredited industry certification programs should be used for every product to provide credibility and quality assurance for retail and carrier based customers looking to add ever increasing num...
Oct. 25, 2016 02:00 AM EDT Reads: 612
In the next forty months – just over three years – businesses will undergo extraordinary changes. The exponential growth of digitization and machine learning will see a step function change in how businesses create value, satisfy customers, and outperform their competition. In the next forty months companies will take the actions that will see them get to the next level of the game called Capitalism. Or they won’t – game over. The winners of today and tomorrow think differently, follow different...
Oct. 25, 2016 01:15 AM EDT Reads: 1,024
“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. CloudBerry Backup is a leading cross-platform cloud backup and disaster recovery solution integrated with major public cloud services, such as Amazon Web Services, Microsoft Azure and Google Cloud Platform.
Oct. 25, 2016 01:15 AM EDT Reads: 1,411
SYS-CON Events announced today that Super Micro Computer, Inc., a global leader in Embedded and IoT solutions, will exhibit at SYS-CON's 20th International Cloud Expo®, which will take place on June 7-9, 2017, at the Javits Center in New York City, NY. Supermicro (NASDAQ: SMCI), the leading innovator in high-performance, high-efficiency server technology, is a premier provider of advanced server Building Block Solutions® for Data Center, Cloud Computing, Enterprise IT, Hadoop/Big Data, HPC and ...
Oct. 25, 2016 01:15 AM EDT Reads: 3,615
Web Real-Time Communication APIs have quickly revolutionized what browsers are capable of. In addition to video and audio streams, we can now bi-directionally send arbitrary data over WebRTC's PeerConnection Data Channels. With the advent of Progressive Web Apps and new hardware APIs such as WebBluetooh and WebUSB, we can finally enable users to stitch together the Internet of Things directly from their browsers while communicating privately and securely in a decentralized way.
Oct. 25, 2016 12:15 AM EDT Reads: 1,859
For basic one-to-one voice or video calling solutions, WebRTC has proven to be a very powerful technology. Although WebRTC’s core functionality is to provide secure, real-time p2p media streaming, leveraging native platform features and server-side components brings up new communication capabilities for web and native mobile applications, allowing for advanced multi-user use cases such as video broadcasting, conferencing, and media recording.
Oct. 25, 2016 12:00 AM EDT Reads: 4,185
SYS-CON Events announced today that LeaseWeb USA, a cloud Infrastructure-as-a-Service (IaaS) provider, will exhibit at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. LeaseWeb is one of the world's largest hosting brands. The company helps customers define, develop and deploy IT infrastructure tailored to their exact business needs, by combining various kinds cloud solutions.
Oct. 24, 2016 11:15 PM EDT Reads: 3,857
SYS-CON Events announced today that Hitrons Solutions will exhibit at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. Hitrons Solutions Inc. is distributor in the North American market for unique products and services of small and medium-size businesses, including cloud services and solutions, SEO marketing platforms, and mobile applications.
Oct. 24, 2016 11:00 PM EDT Reads: 2,022
Successful digital transformation requires new organizational competencies and capabilities. Research tells us that the biggest impediment to successful transformation is human; consequently, the biggest enabler is a properly skilled and empowered workforce. In the digital age, new individual and collective competencies are required. In his session at 19th Cloud Expo, Bob Newhouse, CEO and founder of Agilitiv, will draw together recent research and lessons learned from emerging and established ...
Oct. 24, 2016 09:45 PM EDT Reads: 1,387
November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. Penta Security is a leading vendor for data security solutions, including its encryption solution, D’Amo. By using FPE technology, D’Amo allows for the implementation of encryption technology to sensitive data fields without modification to schema in the database environment. With businesses having their data become increasingly more complicated in their mission-critical applications (such as ERP, CRM, HRM), continued ...
Oct. 24, 2016 08:45 PM EDT Reads: 1,051