|By Business Wire||
|November 5, 2012 11:16 AM EST||
SAI Global Compliance, the world’s leading provider of governance, risk and compliance (GRC) products, services and technology, including the Compliance 360® software suite, today announced a new application for healthcare providers, Claims Denial Manager, specifically designed to help minimize revenue loss due to pre-payment claims denials, primarily from commercial payers. Also announced are significant enhancements to its industry-leading Claims Audit Manager application, also for healthcare providers.
Amidst increasing government audits aimed at reducing erroneous billing in the Medicare and Medicaid programs, as well as increasing claims payment denials from private insurance carriers, the revenues and profits of healthcare providers face unprecedented challenges. SAI Global is providing new, advanced systems to help healthcare providers address all of these financial risks.
Today, thousands of healthcare facilities across the United States are using the Compliance 360 Claims Audit Manager to minimize revenue loss by ensuring that legitimate claims are not caught up in increasingly aggressive government audit programs. The Claims Audit Manager functions as a “Virtual Audit Coordinator,” enforcing deadlines and due dates throughout the healthcare organization and providing alerts to ensure effective management of complex appeals processes and avoidance of automatic revenue recoupment. The enhanced Claims Audit Manager increases the level of automation and includes a new underlying architecture that enables a higher degree of configuration by the customer, including the ability to customize application forms and add customer-specific data fields. The enhancements also include a variety of pre-configured reports as well as a new graphical report layout designer for easily creating custom reports.
Based on the same powerful platform and leveraging years of experience and success with the widely proven Claims Audit Manager, SAI Global is also introducing the new Claims Denial Manager application. Managing pre-payment claims denials, such as those common from commercial payers, is a significant challenge for many healthcare providers. Industry statistics indicate that healthcare providers write-off 3 to 5 percent of net revenue due to denials because they lack a comprehensive denials management program. This can equate to millions of dollars in potentially recoverable revenue for the average hospital. With most providers submitting claims to multiple payers, identifying denials, analyzing the claims to determine root causes, collecting information to support a resubmission or appeal and implementing cross-departmental process improvements is impractical without automation. The new Claims Denial Manager solution is designed to help providers manage the claims denial process with the tools needed to quickly identify and analyze denied claims, increase accountability and ultimately improve net revenue capture.
“Market acceptance of our Claims Audit Manager application has been outstanding,” said Steve McGraw, GRC president, SAI Global Compliance. “We estimate that our hospital customers have successfully appealed claims audit denials totaling $40 million in legitimate revenues with the support of our Claims Audit Manager, and substantially more is pending in active appeals. Based on this success and specific requests from our customers, we’ve developed the new Claims Denial Manager application. Used in combination with the Compliance 360 Claims Audit Manager application, healthcare providers will have the complete visibility needed to monitor and proactively manage all of their financial exposure stemming from pre-payment and post-payment claims audits and denied claims.”
According to Dr. Larry Hegland, chief medical officer for Ministry Health Care, “Payment denials from health insurance organizations are a constant challenge, creating additional pressure on the bottom line for most healthcare providers. As both sides of this equation strive to maintain revenues and margins, we expect to see increasing challenges from claims payment denials. We are glad to see that SAI Global has leveraged the experience gained with their widely deployed solution for managing RAC, MIC and other government-driven revenue audits to design and deliver this new application for managing pre-payment denials.”
The enhanced version of the Claims Audit Manager and the new Claims Denial Manager application are both generally available now from SAI Global. A broadcast demonstration of the Claims Denial Manager application is scheduled for Nov. 28, 2012, at 2:00 p.m. EST. Visit www.compliance360.com/webdemos for more details.
About Compliance 360® GRC Software Suite
The original Governance, Risk and Compliance (GRC) software solutions born in the cloud, Compliance 360 brings order and efficiency to the complexity of enterprise governance, risk management, compliance and audit management. The Compliance 360 GRC Software Suite includes regulatory compliance software, policy management software, internal audit software, incident management software, ERM software and a wide variety of specialty applications. More than 250,000 professionals every day in financial services, insurance, healthcare, distribution and other regulated industries rely on Compliance 360 applications to help protect their revenues, reputations and brands. www.compliance360.com
About SAI Global Compliance
SAI Global Compliance provides organizations with a wide range of governance, risk and compliance (GRC) products, solutions and services that help build organizational integrity and meet overall business objectives. With more than 25 years experience and offices in more than 25 countries, SAI Global’s solutions include a wide range of GRC products and services, including the Compliance 360 GRC Software Suite, best practice Code of Conduct program services and training, compliance and ethics training and awareness, risk and culture assessments, a full range of advisory services, whistleblowing hotline services, regulatory knowledge, policy management, case management and third-party compliance management, including automated due diligence workflow and management. www.saiglobal.com/compliance
The Internet of Things is not new. Historically, smart businesses have used its basic concept of leveraging data to drive better decision making and have capitalized on those insights to realize additional revenue opportunities. So, what has changed to make the Internet of Things one of the hottest topics in tech? In his session at @ThingsExpo, Chris Gray, Director, Embedded and Internet of Things, discussed the underlying factors that are driving the economics of intelligent systems. Discover how hardware commoditization, the ubiquitous nature of connectivity, and the emergence of Big Data a...
Dec. 21, 2014 02:00 PM EST Reads: 2,377
"BSQUARE is in the business of selling software solutions for smart connected devices. It's obvious that IoT has moved from being a technology to being a fundamental part of business, and in the last 18 months people have said let's figure out how to do it and let's put some focus on it, " explained Dave Wagstaff, VP & Chief Architect, at BSQUARE Corporation, in this SYS-CON.tv interview at @ThingsExpo, held Nov 4-6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 21, 2014 01:00 PM EST Reads: 2,005
The major cloud platforms defy a simple, side-by-side analysis. Each of the major IaaS public-cloud platforms offers their own unique strengths and functionality. Options for on-site private cloud are diverse as well, and must be designed and deployed while taking existing legacy architecture and infrastructure into account. Then the reality is that most enterprises are embarking on a hybrid cloud strategy and programs. In this Power Panel at 15th Cloud Expo (http://www.CloudComputingExpo.com), moderated by Ashar Baig, Research Director, Cloud, at Gigaom Research, Nate Gordon, Director of T...
Dec. 21, 2014 11:30 AM EST Reads: 2,422
SYS-CON Events announced today that IDenticard will exhibit at SYS-CON's 16th International Cloud Expo®, which will take place on June 9-11, 2015, at the Javits Center in New York City, NY. IDenticard™ is the security division of Brady Corp (NYSE: BRC), a $1.5 billion manufacturer of identification products. We have small-company values with the strength and stability of a major corporation. IDenticard offers local sales, support and service to our customers across the United States and Canada. Our partner network encompasses some 300 of the world's leading systems integrators and security s...
Dec. 21, 2014 10:00 AM EST Reads: 2,161
SYS-CON Events announced today that Windstream, a leading provider of advanced network and cloud communications, has been named “Silver Sponsor” of SYS-CON's 16th International Cloud Expo®, which will take place on June 9–11, 2015, at the Javits Center in New York, NY. Windstream (Nasdaq: WIN), a FORTUNE 500 and S&P 500 company, is a leading provider of advanced network communications, including cloud computing and managed services, to businesses nationwide. The company also offers broadband, phone and digital TV services to consumers primarily in rural areas.
Dec. 21, 2014 08:30 AM EST Reads: 2,288
ARMONK, N.Y., Nov. 20, 2014 /PRNewswire/ -- IBM (NYSE: IBM) today announced that it is bringing a greater level of control, security and flexibility to cloud-based application development and delivery with a single-tenant version of Bluemix, IBM's platform-as-a-service. The new platform enables developers to build ap...
Dec. 21, 2014 06:15 AM EST Reads: 2,128
The BPM world is going through some evolution or changes where traditional business process management solutions really have nowhere to go in terms of development of the road map. In this demo at 15th Cloud Expo, Kyle Hansen, Director of Professional Services at AgilePoint, shows AgilePoint’s unique approach to dealing with this market circumstance by developing a rapid application composition or development framework.
Dec. 20, 2014 11:00 PM EST Reads: 1,375
“In the past year we've seen a lot of stabilization of WebRTC. You can now use it in production with a far greater degree of certainty. A lot of the real developments in the past year have been in things like the data channel, which will enable a whole new type of application," explained Peter Dunkley, Technical Director at Acision, in this SYS-CON.tv interview at @ThingsExpo, held Nov 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 20, 2014 08:00 AM EST Reads: 1,388
DevOps Summit 2015 New York, co-located with the 16th International Cloud Expo - to be held June 9-11, 2015, at the Javits Center in New York City, NY - announces that it is now accepting Keynote Proposals. The widespread success of cloud computing is driving the DevOps revolution in enterprise IT. Now as never before, development teams must communicate and collaborate in a dynamic, 24/7/365 environment. There is no time to wait for long development cycles that produce software that is obsolete at launch. DevOps may be disruptive, but it is essential.
Dec. 18, 2014 09:45 PM EST Reads: 1,249
"People are a lot more knowledgeable about APIs now. There are two types of people who work with APIs - IT people who want to use APIs for something internal and the product managers who want to do something outside APIs for people to connect to them," explained Roberto Medrano, Executive Vice President at SOA Software, in this SYS-CON.tv interview at Cloud Expo, held Nov 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 18, 2014 09:00 AM EST Reads: 1,382
Nigeria has the largest economy in Africa, at more than US$500 billion, and ranks 23rd in the world. A recent re-evaluation of Nigeria's true economic size doubled the previous estimate, and brought it well ahead of South Africa, which is a member (unlike Nigeria) of the G20 club for political as well as economic reasons. Nigeria's economy can be said to be quite diverse from one point of view, but heavily dependent on oil and gas at the same time. Oil and natural gas account for about 15% of Nigera's overall economy, but traditionally represent more than 90% of the country's exports and as...
Dec. 18, 2014 06:00 AM EST Reads: 933
The Internet of Things is a misnomer. That implies that everything is on the Internet, and that simply should not be - especially for things that are blurring the line between medical devices that stimulate like a pacemaker and quantified self-sensors like a pedometer or pulse tracker. The mesh of things that we manage must be segmented into zones of trust for sensing data, transmitting data, receiving command and control administrative changes, and peer-to-peer mesh messaging. In his session at @ThingsExpo, Ryan Bagnulo, Solution Architect / Software Engineer at SOA Software, focused on desi...
Dec. 17, 2014 11:15 PM EST Reads: 1,426
"At our booth we are showing how to provide trust in the Internet of Things. Trust is where everything starts to become secure and trustworthy. Now with the scaling of the Internet of Things it becomes an interesting question – I've heard numbers from 200 billion devices next year up to a trillion in the next 10 to 15 years," explained Johannes Lintzen, Vice President of Sales at Utimaco, in this SYS-CON.tv interview at @ThingsExpo, held Nov 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 17, 2014 11:00 PM EST Reads: 1,465
"For over 25 years we have been working with a lot of enterprise customers and we have seen how companies create applications. And now that we have moved to cloud computing, mobile, social and the Internet of Things, we see that the market needs a new way of creating applications," stated Jesse Shiah, CEO, President and Co-Founder of AgilePoint Inc., in this SYS-CON.tv interview at 15th Cloud Expo, held Nov 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Dec. 17, 2014 08:00 PM EST Reads: 1,457
SYS-CON Events announced today that Gridstore™, the leader in hyper-converged infrastructure purpose-built to optimize Microsoft workloads, will exhibit at SYS-CON's 16th International Cloud Expo®, which will take place on June 9-11, 2015, at the Javits Center in New York City, NY. Gridstore™ is the leader in hyper-converged infrastructure purpose-built for Microsoft workloads and designed to accelerate applications in virtualized environments. Gridstore’s hyper-converged infrastructure is the industry’s first all flash version of HyperConverged Appliances that include both compute and storag...
Dec. 17, 2014 06:30 PM EST Reads: 1,397
Today’s enterprise is being driven by disruptive competitive and human capital requirements to provide enterprise application access through not only desktops, but also mobile devices. To retrofit existing programs across all these devices using traditional programming methods is very costly and time consuming – often prohibitively so. In his session at @ThingsExpo, Jesse Shiah, CEO, President, and Co-Founder of AgilePoint Inc., discussed how you can create applications that run on all mobile devices as well as laptops and desktops using a visual drag-and-drop application – and eForms-buildi...
Dec. 17, 2014 11:45 AM EST Reads: 1,567
We certainly live in interesting technological times. And no more interesting than the current competing IoT standards for connectivity. Various standards bodies, approaches, and ecosystems are vying for mindshare and positioning for a competitive edge. It is clear that when the dust settles, we will have new protocols, evolved protocols, that will change the way we interact with devices and infrastructure. We will also have evolved web protocols, like HTTP/2, that will be changing the very core of our infrastructures. At the same time, we have old approaches made new again like micro-services...
Dec. 16, 2014 11:45 PM EST Reads: 1,415
Code Halos - aka "digital fingerprints" - are the key organizing principle to understand a) how dumb things become smart and b) how to monetize this dynamic. In his session at @ThingsExpo, Robert Brown, AVP, Center for the Future of Work at Cognizant Technology Solutions, outlined research, analysis and recommendations from his recently published book on this phenomena on the way leading edge organizations like GE and Disney are unlocking the Internet of Things opportunity and what steps your organization should be taking to position itself for the next platform of digital competition.
Dec. 15, 2014 11:45 PM EST Reads: 1,750
The 3rd International Internet of @ThingsExpo, co-located with the 16th International Cloud Expo - to be held June 9-11, 2015, at the Javits Center in New York City, NY - announces that its Call for Papers is now open. The Internet of Things (IoT) is the biggest idea since the creation of the Worldwide Web more than 20 years ago.
Dec. 15, 2014 10:30 AM EST Reads: 6,924
As the Internet of Things unfolds, mobile and wearable devices are blurring the line between physical and digital, integrating ever more closely with our interests, our routines, our daily lives. Contextual computing and smart, sensor-equipped spaces bring the potential to walk through a world that recognizes us and responds accordingly. We become continuous transmitters and receivers of data. In his session at @ThingsExpo, Andrew Bolwell, Director of Innovation for HP's Printing and Personal Systems Group, discussed how key attributes of mobile technology – touch input, sensors, social, and ...
Dec. 15, 2014 10:00 AM EST Reads: 1,990