Leading HealthTech Provider Relies on Sigma to Optimize Claim Acceptance
公司规模
1,000+
地区
- America
国家
- United States
产品
- Sigma
- Snowflake
技术栈
- Cloud Data Warehouses
- Spreadsheet Interface
实施规模
- Enterprise-wide Deployment
影响指标
- Customer Satisfaction
- Digital Expertise
- Productivity Improvements
技术
- 分析与建模 - 预测分析
- 应用基础设施与中间件 - 数据交换与集成
- 平台即服务 (PaaS) - 数据管理平台
适用行业
- 医疗保健和医院
适用功能
- 商业运营
用例
- 质量预测分析
- 过程控制与优化
- 监管合规监控
服务
- 数据科学服务
- 系统集成
关于客户
The customer is a top 10 healthcare technology company in the United States, specializing in Electronic Health Records (EHR) solutions. The company partners with medical organizations to drive clinical and financial results. With a vast amount of data, including 100 million rows of claims data, the company’s Rules team is responsible for implementing rules that reduce denials based on payer processing requirements. The company aims to optimize its claim acceptance rate and deliver a higher level of service to its clients.
挑战
The healthcare technology company faced significant challenges in optimizing its claim acceptance rate due to scale limitations and an inability to anticipate changing data needs. The Rules team struggled to identify which rules caused billing errors and resolve claims on the first pass. Obtaining data extracts for analysis in Excel involved a lot of back and forth with the data team, taking up to 30 days to see if new rules improved or negatively impacted the claim acceptance rate. This lack of timely access to data hindered the Rules team’s effectiveness, prevented the company from expanding its scope of work for clients, and impeded their ability to deliver a higher level of service.
解决方案
The company adopted Sigma, a cloud-native solution purpose-built for Snowflake and cloud data warehouses. This provided the Rules team with direct access to live, governed data in Snowflake, ensuring everyone works with the same current data. Sigma’s unlimited scale and speed allowed the team to analyze billions of rows of claims data quickly, identifying the cause of denials and trends or patterns. Sigma’s spreadsheet interface enabled self-service data exploration, allowing the Rules team to model the impact of new rules before implementation, ensuring they positively impact claims acceptance.
运营影响
数量效益
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