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HCL Technologies

Provider Revenue Cycle Management

Provider Revenue Cycle Management

Client Information

A large U.S. healthcare service provider group providing multi-specialty care and diagnostics and genomic test services across several states in the U.S.

Business Challenges

  • Rising incidents of patient self-pay and bad debts
  • Reimbursement cuts across the board from Government and commercial payers
  • Transition from ICD 9 to ICD 10
  • Increasing focus on payment integrity by payers, to reduce medical payouts
  • Expansion of utilization management and reviews

HCL Solution

This solution applies autonomic science and predictive analytics to maximize revenue cycle outcomes by using new generation technologies. It provides:

  • Process industrialization across payers and specialties
  • HCL Toscana EDEN – plug and play point solution for RCM acceleration
  • Adaptive rules engine
  • Real time predictive analytics
  • Intelligent denial analytics

Value Delivered

  • Upfront performance guarantee for revenue cycle outcomes
  • 23% increase in cash flow
  • 18% reduction in DSO
  • 6% increase in collection ratio
  • 30% reduction in administrative costs beyond traditional ‘Lift & Shift’ BPO
  • 20% increase in patient satisfaction
  • 32% reduction in rework for rejects, denials and appeals