Case Study: NeuGen HealthCheck

NeuGen, a regional Shared Services organization, adopted HealthRules Payer in 2012 to automate claims payments and enhance information transparency. Over time, as the healthcare industry evolved, NeuGen sought to optimize their system for greater operational efficiency. By partnering with HealthEdge’s Professional Services and utilizing the HealthCheck solution, they identified several areas for improvement.

Challenges and Objectives

NeuGen aimed to address billing age calculation issues, explore alternative configuration options, improve accumulator reporting, and reduce manual work for fee table maintenance. The primary goal was to enhance their system's functionality and efficiency.

Solution

HealthCheck provided an in-depth evaluation of NeuGen’s HealthRules Payer system, uncovering opportunities to optimize processes and reduce manual work. The recommendations included:

• Utilizing alternative configuration options for plans with billing age issues.
• Adjusting deductible and maximum configurations for non-embedded plans.
• Implementing changes on pended claims and reducing preprocess reports.

Results

The implementation of HealthCheck recommendations led to significant benefits:

• Time and cost savings by reducing manual workarounds.
• Enhanced payment accuracy and increased auto adjudication rates.
• Improved data integrity in enrollment processes.
• Reduced manual corrections for accumulator amounts when coverage tiers change.

One notable achievement was automating the DRG pricing approach, saving NeuGen between 80-160 hours of manual work annually, with an additional 66+ hours reallocated to other tasks. Going forward, NeuGen plans to implement best practices to further reduce manual work, improve accuracy, and save time and costs.

Learn more about how HealthCheck can help your organization reduce manual work for claims processing and drive operational efficiency.