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Alphalytics in Action

Labor & Delivery

Lumedic Alphalytics is a team of experts who are committed to leveraging advanced technology in concert with our Agile product development strategy to provide you strategic and impactful insights into your first-pass performance on submitted claims. Utilizing machine-based learning technology, we uncover the hidden data patterns behind your initial denial and underpayment rates.

ISSUE

Labor & Delivery Story

An Alphalytics profile identified that a managed Medicaid payer was initially denying over 90% of labor & delivery observation claims from one facility within the health system due to non-specific diagnosis coding.

SOLUTION

Identification and Correction

After researching the accounts identified by Alphalytics, the health system determined this facility's labor & delivery observation coding was too general versus its other facilities. Client revised documentation & coding training programs, and then retrained staff at this facility resolving the issue.

CONCLUSION

*Positively Impacting Cashflow*

Utilizing Alphalytics to identify non-obvious issues positively impacted this client's cash flow.

While this profile pinpointed one payer, the Alphalytics provider & payer benchmarking features helped the client realize approximately 35% of all labor & delivery observation claims at this facility were initially denied delaying payment by an average of 78 days. Unfortunately, while payment was received, the client's time to collect was 3 times longer than expected.

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