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