Red Sky Health Emphasizes Critical Need for Streamlined Insurance Claims Processing
Recent tragic events serve as a stark reminder of the immense pressure and stress surrounding the healthcare industry. This pressure extends beyond executives; it impacts patients, providers, and the entire healthcare ecosystem. Denials contribute significantly to this stress, creating financial hardship for providers and delaying critical patient care. The constant battle with insurance companies, the administrative burden of resubmitting claims, and the fear of financial instability can take a significant toll on mental and emotional well-being.
These challenges underscores the need for a deeper examination of the systemic issues within the healthcare industry, including insurance reimbursement complexities and administrative burdens that hinder patient care. Streamlining claims processing is not just about efficiency; it's about creating a more sustainable and supportive environment for those getting the care, and those providing it. By leveraging advanced technologies such as AI and machine learning, it is possible to create a more streamlined healthcare system that benefits patients, providers, and payers alike.
Red Sky Health reiterates and supports the urgent need for more efficient approaches to insurance claims processing which should result in more patient-centric focus. Current estimates show that $600 billion dollars in claims are denied annually on first review by an insurance company. This causes significant financial losses for providers, increasing patient out of pocket expenses and requiring additional administrative costs to resubmit denied claims. Importantly, these denials create unnecessary stress for patients and providers and increase the cost of insurance and of healthcare services. However, with appropriate changes in billing practices, research consistently indicates that 70-85% of all denials are potentially avoidable.
Red Sky Health is addressing this situation through its artificial intelligence claims engine, “Daniel.” Our experience with contracted providers show that we have been able to recommend changes with high precision to reduce first pass, professional claims denials by 30% after Daniel’s implementation. The reduction of denials creates an opportunity for a more harmonious relationship between patient, provider and payor.
To help support this need for better healthcare relationships, Red Sky Health's machine learning-powered solution is designed to address these challenges by:
Automating routine tasks: Streamlining claim submissions, decreasing denials management, and speeding prior authorizations, freeing up valuable time for healthcare providers to focus on patient care.
Improving accuracy: Using AI and machine learning to identify and resolve errors, and suggest revisions at a higher level of precision, minimizing claim denials and ensuring timely reimbursements.
Reducing administrative costs: Automating processes and minimizing manual intervention significantly reduces administrative overhead for both providers and payers.
Enhancing patient experience: By streamlining the claims process, providers can better focus on delivering high-quality care and improving patient satisfaction.
“The recent events underscore the importance of a healthcare system that prioritizes patient well-being and operational efficiency,” says Jai Pillai, COO, Red Sky Health. “By leveraging advanced technologies like machine learning, we can help create a more streamlined and equitable healthcare system that benefits patients, providers, and payers alike.”
This tragedy as well as the overall challenges should be a wake-up call for the entire healthcare industry. We must prioritize patient care, reduce administrative burdens, and work together to create a more equitable and compassionate system for all. Red Sky Health partners with healthcare providers and payers to streamline insurance claims, improve accuracy, and reduce costs. Our solutions empower stakeholders to deliver better patient care.
About Red Sky Health:
Red Sky Health leadership brings over 90 years of both provider and health insurance expertise, with key staff having experience in Provider Practice Management, Hospital Ownership and Leadership, Provider Reimbursement, Quality and Provider Network Leadership.
This unique combination of experience not only identifies opportunities to prevent or reduce claims denials but also allows us to assist providers in dealing with insurance companies.
