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Company
Georgia Healthcare Partnership, Inc.
Customer Profile
GHP is a full-service managed care organization that provides services in 32
counties throughout Georgia and South Carolina with more than 52,000 covered
lives.
Business Challenge
GHP and Memorial Health University Medical Center experienced a
7% (unacceptibly high) rate of initially denied patient health benefit
claims, resulting in a monthly loss of around $7 million, due to
inconsistencies in insurance verification across departments.
Solution Description
PST built a complete web-based insurance verification system which dropped the
denial rate from 7% to 2%, resulting in a monthly cash flow improvement of $5
million.
Benefits
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Reduce denial rate from 7% to 2%.
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Improve monthly cash flow by $5 million.
-
Reduce benefit verification time and redundancy.
-
Improve secure communications between hospital registration and benefit
providers.
Software and Services
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Windows 2000 Server
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SQL Server 2000
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ASP.NET interactive website
Vertical Industries
Heathcare
Country/Region
Southeast United States
Audiences
Business Decision Makers
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When Georgia Healthcare Partnership (GHP) and Memorial
Health University Medical Center needed to improve their patient benefits
verification system, they looked to PST to design a solution that would aid the
reduction of claims denial and improve consistency of information.
Company Overview
Georgia Healthcare Partnership, Inc., (GHP), is a full-service managed care
organization that provides services in 32 counties throughout Georgia and South
Carolina. GHP currently offers services in 24 hospitals and has more than 1,700
physician providers and 500 ancillary providers in all specialties. GHP ensures
that all providers have the appropriate credentials, licenses, hospital
privileges, and commendable records of service. The GHP network provides
comprehensive medical management, including utilization review, utilization
management, large case management, HealthyOne disease management, pharmacy
benefits management, and employee assistance programs. GHP is one of the
largest networks in southeast Georgia, with more than 52,000 covered lives.
Business Challenge
The information systems team at GHP was seeking to provide a streamlined,
accurate, and fast health benefits verification system for Memorial Health
University Medical Center, GHP's primary customer The medical center was
losing up to $5 million per month in denials of benefits claims for treatments
and procedures already completed. This loss arose from the fact that
various departments in the center had to go to excessive lengths to verify each
patient's benefits with insurance providers, using many different manual
methods. Insurance product information was not readily available to
registration or case management departments. Losses arose when treatments
were administered before responses came back from provders (due
to emergency cases over a weekend, for example), and when staff members
had to re-submit and re-verify claims.
Solution
Utilizing the technologies of ASP.NET and SQL Server 2000, PST built
a complete, two-tier website for benefits verification. On one tier, the
administrative section, benefits specialists at GHP and at the center can
maintain up-to-date information for all health benefits providers conducting
business in the center's coverage area. On the other tier, registration
and emergency room staff can verify a patient's benefits immediately, online.
The application is built on a single web server (on the
Memorial-GHP Intranet), with all updates and retrievals performed against a
single database. Additions and updates made by benefits specialists are
immediately visible to registration and ER staff. The system provides a common,
consistent and secure interface for all users.
Benefits
-
Reduce denial rate from 7% to 2%.
-
Improve monthly cash flow by $5 million.
-
Reduce benefit verification time and redundancy.
-
Improve secure communications between hospital registration and benefit
providers.
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