{"id":7497,"date":"2025-06-25T15:16:32","date_gmt":"2025-06-25T09:46:32","guid":{"rendered":"https:\/\/www.healthasyst.com\/healthcare-it-services\/?p=7497"},"modified":"2025-09-16T17:07:49","modified_gmt":"2025-09-16T11:37:49","slug":"building-a-real-time-claims-analytics-solution-to-detect-underpayments","status":"publish","type":"post","link":"https:\/\/www.healthasyst.com\/healthcare-it-services\/building-a-real-time-claims-analytics-solution-to-detect-underpayments\/","title":{"rendered":"Building a Real-Time Claims Analytics Solution to Detect Underpayments"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"7497\" class=\"elementor elementor-7497\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section data-marvy_enable_drop_animation=\"false\" data-marvy_enable_fancy_rotate=\"false\" data-marvy_enable_flying_object=\"false\" data-marvy_enable_ripples_animation=\"false\" data-marvy_enable_waves_animation=\"false\" data-marvy_enable_rings_animation=\"false\" data-marvy_enable_topology_animation=\"false\" data-marvy_enable_gradient_animation=\"false\" data-marvy_enable_snow_animation=\"false\" data-marvy_enable_firework_animation=\"false\" data-marvy_enable_cloud_animation=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-2f6063b7 elementor-section-boxed elementor-section-height-default elementor-section-height-default exad-glass-effect-no exad-sticky-section-no\" data-id=\"2f6063b7\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4d276f91 exad-glass-effect-no exad-sticky-section-no\" data-id=\"4d276f91\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-466d1459 exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-text-editor\" data-id=\"466d1459\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The customer is a U.S.-based healthcare technology company that offers innovative revenue cycle management (RCM) solutions.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-marvy_enable_drop_animation=\"false\" data-marvy_enable_fancy_rotate=\"false\" data-marvy_enable_flying_object=\"false\" data-marvy_enable_ripples_animation=\"false\" data-marvy_enable_waves_animation=\"false\" data-marvy_enable_rings_animation=\"false\" data-marvy_enable_topology_animation=\"false\" data-marvy_enable_gradient_animation=\"false\" data-marvy_enable_snow_animation=\"false\" data-marvy_enable_firework_animation=\"false\" data-marvy_enable_cloud_animation=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-2668126e elementor-section-boxed elementor-section-height-default elementor-section-height-default exad-glass-effect-no exad-sticky-section-no\" data-id=\"2668126e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-60507908 exad-glass-effect-no exad-sticky-section-no\" data-id=\"60507908\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3ddabf2d exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"3ddabf2d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">The Need<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-271edf87 exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-text-editor\" data-id=\"271edf87\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Claims underpayments cost U.S. healthcare providers millions in lost revenue every year. Studies show that healthcare providers lose up to 11% of their net patient revenue due to underpayments. Therefore, as providers prioritize sustainability and operational efficiency, identifying and recovering underpayments has become a top priority. The customer wanted to build an analytical solution that would help their clients (providers) detect and appeal underpaid claims.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9e3ab84 elementor-widget-divider--view-line exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-divider\" data-id=\"9e3ab84\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f3e3642 exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"f3e3642\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">The Challenge<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-080410f exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-text-editor\" data-id=\"080410f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li><p>High-volume rule processing with rapid response times: The analytics solution had to process a large and diverse set of over 60,000 rules. These rules spanned Medicaid and Medicare fee schedules, payer-specific contracts, and billing compliance standards. The solution had to process these rules and deliver results in just a few seconds.<\/p><\/li><li><p>Real-time, revenue-critical performance <br \/>The system was expected to function in real time. Any lag or missed response window could lead to missed revenue opportunities for both the customer and their provider clients.<\/p><\/li><li><p>Sophisticated data matching across multiple sources <br \/>The platform needed to reconcile claims data, both submitted and adjudicated, against varied state-level pricing structures and payer-specific reimbursement terms. This called for a highly tuned data model and an optimized Extract-Transform-Load (ETL) workflow.<\/p><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-33171bbc exad-glass-effect-no exad-sticky-section-no\" data-id=\"33171bbc\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7f6edef4 exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"7f6edef4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Get it now<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-189000ae exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-text-editor\" data-id=\"189000ae\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7496-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7496\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/healthcare-it-services\/wp-json\/wp\/v2\/posts\/7497#wpcf7-f7496-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"7496\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" 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aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>The customer is a U.S.-based healthcare technology company that offers innovative revenue cycle management (RCM) solutions. The Need Claims underpayments cost U.S. healthcare providers millions in lost revenue every year. Studies show that healthcare providers lose up to 11% of their net patient revenue due to underpayments. Therefore, as providers prioritize sustainability and operational efficiency, [&hellip;]<\/p>\n","protected":false},"author":24,"featured_media":7498,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[4,5],"tags":[],"ppma_author":[197],"class_list":["post-7497","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-study","category-featured","entry","has-media"],"acf":[],"authors":[{"term_id":197,"user_id":24,"is_guest":0,"slug":"ha-arjun","display_name":"Arjun Bajaj","avatar_url":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-content\/uploads\/2024\/02\/Arjun-e1708965959245-150x150.jpg","user_url":"https:\/\/www.healthasyst.com","last_name":"Bajaj","first_name":"Arjun","job_title":"","description":"<span data-teams=\"true\">Arjun Bajaj is a seasoned Pre-Sales and Business Development leader with 14 years of experience driving sales and consulting engagements for fintech and healthcare IT clients. Currently, at HealthAsyst, he leverages his expertise in go-to-market strategies and business partnerships to foster growth and shape impactful sales strategies within the U.S. healthcare sector.<\/span>"}],"_links":{"self":[{"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/posts\/7497","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/users\/24"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/comments?post=7497"}],"version-history":[{"count":4,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/posts\/7497\/revisions"}],"predecessor-version":[{"id":7502,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/posts\/7497\/revisions\/7502"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/media\/7498"}],"wp:attachment":[{"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/media?parent=7497"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/categories?post=7497"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/tags?post=7497"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.healthasyst.com\/healthcare-it-services\/wp-json\/wp\/v2\/ppma_author?post=7497"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}