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June 12, 2020 By SmartLight News Desk

Can healthcare claims analytics save employers money?

The American healthcare system has become increasingly more elaborate and difficult to navigate over the past several decades. COVID-19 did nothing to help that, in fact, the crisis made it more complicated as restrictions were reduced to deal with the pandemic. Within this environment of complexity and rising costs, over 95% of employers are now funding their own employees healthcare and are going to need to contain those costs now more than ever. Industry experts estimate that billions of dollars are leaking out of the system with no measurable improvement in patient health. Are employers left with any options? 

To significantly reduce this waste, SmartLight Analytics, LLC was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight uses statistical, clinical, and data expertise to deliver the most complete cost reduction solution directly to the actual stakeholders – self-funded employers. Since processing claims is outside the core competency of most employers, patterns of error often go unnoticed and result in the unnecessary spend of health plan dollars. Regular, deep analytic reviews deliver a low-touch, high-impact solution to self-funded employers. 

Millions, even billions, of dollars are spent annually providing healthcare coverage for employees across the U.S. Adjudication of medical services is complex and requires specialized expertise. Employers focus on selling their own products and outsource medical claim payments to third-party administrators. Consequently, there is limited transparency for the employers in this process resulting an avoidable cost being spent on the employer’s behalf. An expert in inferential analytics and clinical data is needed to evaluate payments for appropriateness. Having the independent review of payments reduces annual spend between 3 and 5%.  It is an option more employers will want to have in their toolkits, especially those with 10,000 or more employees. Employers with high numbers of white-collar employees or union members can most benefit from the recovery of these lost dollars due to fraud, waste, and abuse. It is money left on the table when every dollar is needed to keep businesses afloat and back into recovery. 

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Filed Under: costs, fraud, healthcare

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4965 Preston Park Blvd. Suite 350
Plano, TX 75093
Phone: 214-501-1046
Fax: 214-501-1208

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SmartLight Analytics combines the best inferential analytic models with a team of analytic  and clinical experts to find fraud, waste, and abuse in self-funded employer health care plan claims data.
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SmartLight Analytics has been named finalists in D CEO Magazine Excellence in Healthcare Awards 2020 for Outstanding Service Innovation.

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