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UNC Health leverages Availity to cut claim errors and trim costs

About UNC Health

UNC Health is an integrated, nonprofit healthcare system, owned by the state of North Carolina and based in Chapel Hill. Established in 1998, UNC Health includes 11 affiliated hospitals and 2 provider networks across the state with a combined 3,373 beds, a network of over 4,000 providers and clinical programs through the UNC School of Medicine.

Challenge:

UNC Health underwent an aggressive implementation of one of the nation’s leading practice management systems. With a 12-month timeframe and goal of “a single information system across all UNC Health locations that has one patient ID, one problem list, one medication list, and one bill for each patient,” there was little room for error. As physician billing was set-up within their EHR/ PM vendor of choice, UNC Health’s leadership team established three additional goals:

  • 1. prevent denials
  • 2. reduce claims dropped to paper
  • 3. decrease claim rejections.

Solution:

As an existing client, UNC already had confidence in its Availity team but Availity’s experience with installations of their new host system made the implementation process run more smoothly. “We were really excited about the Claims Reconciliation Database (CRD) process,” said Laurie McDaniel, UNC Health’s IT Manager for the Professional Billing Team. “Having the claim runs auto-accepted or auto-rejected is so much better than just wondering if the claims made it out of the system. Within an hour, we have a response back about any eligibility errors or anything else affecting claims.” To meet the ambitious goals and achieve results, UNC Health utilized the Availity Essentials Pro revenue cycle management solution and implemented new processes. UNC Health established new processes for Workers’ Compensation claims by using Availity’s auto-batch attachment solution. In addition, UNC Health adopted Availity’s automatic payer matching capabilities, reviewed claim edits, and pushed new claim rules and logic upstream into their newly implemented practice management system.

Results

The partnership has produced significant reduction in error rates, reduced claim “touches” and decreased administrative costs during a vast growth period at UNC Health. McDaniel noted that Availity’s engagement during the EHR implementation was “extremely helpful,” particularly around claim-acceptance testing. UNC worked with Availity to ensure any issues were identified and resolved prior to go-live by using tools that enabled them to auto-generate large volumes of test files. “It worked really well,” said McDaniel. “Our Availity Account Manager encouraged us to send a lot of files and was really quick in getting back to us with things that needed attention. She made it so easy to test—I didn’t have to worry and hope everything was right. I knew when we went live, our claims were going to be clean.” Within just one year of implementation, UNC Health’s claim error rate dropped from 4.8% to only 0.7%. The claims dropped to paper was also reduced by 60%, saving printing costs and reducing days in account receivable. Compared to other host system integrations, UNC Health leads the pack in reducing the average days to submit. As a result of a successful partnership, UNC Health expanded their use of Availity solutions to improve their revenue cycle. UNC Health’s ongoing collaboration has led to the adoption of auto payer mapping claims, customized Postback Rules, custom edits/rules and the processing of dental claims.

The claims dropped to paper was also reduced by 60%, saving printing costs and reducing days in account receivable

“We are thrilled with our success in partnering with Availity to reduce claim errors, lower costs, and improve attachment capabilities. As we continue to look for improvements in our revenue cycle, we look forward to working with Availity to adopt additional solutions and recommended processes.”

Smitha Katragadda HCS Director of Revenue Cycle, UNC Health

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