“Measure twice. Cut once.”
Apprentices in the trades have this wisdom instilled in them as an inviolable principle — repeated by their masters until the discipline of forethought becomes as natural as the work itself. This reminder to verify your work before committing to an irreversible step is one healthcare knows all too well.
In carpentry, sloppiness wastes valuable building materials. For payers and providers, weak claims processing protocols, denials, and excess resubmissions represent significant costs that yield no clinical benefit — diverting resources away from patient care.
JAMA estimates administrative complexity costs more than $265 billion each year with incorrect and incomplete claims processing as a primary driver. Nearly $20 billion is spent by healthcare providers just to rework and resubmit denied healthcare claims.
What if coding errors could be flagged and corrected before hitting “send?” What if a checklist verified all needed documentation was compiled before a claim was submitted? What if contact center workers were fed cues on next best actions to take while assisting members and providers?
Reduce complexity, improve cash flow
Enter TTEC VeriCycle, an AI-enabled, real-time claims validation platform and contact center empowerment tool that turns revenue cycle complexity into faster, more predictable cash flow. TTEC is proud to unveil this new tool that automates workstreams, prevents unnecessary denials, improves first-pass rates, and overall member satisfaction.
How do you do that? By resolving a call the first time. No repeat calls because the matter is settled.
Intake: Eligibility errors and prior authorization delays result in claim denials that never should have happened. With AI, eligibility can be verified in just seconds. Authorizations can be accelerated by up to 70%.
Coding: Mistakes hinder reimbursement, increase re-work, call volume, and claims appeals. AI embedded in TTEC VeriCycle reads documentation, validates both CPT and ICD 10 codes, and reduces manual effort by up to 80%. The proactive nature of the tool serves to educate providers with alerts like “Your NPI ID is wrong … Eligibility date of service is incorrect … Some documents are missing.” It’s about fixing errors at the point of entry, before anyone hits the “Submit” button.
Real-time visibility: Embedded analytics prioritize denials and informs better decisions. Without such “in the moment” visibility, revenue leakage goes undetected and can snowball fast.
Performance boost: By leveraging AI across the revenue cycle, manual processes are reduced.
Revenue cycle management
Before introducing any new technology to your ecosystem, it’s wise to first step back and scrutinize what systems are there now. Maybe pain points from five years ago are still pain points today. There’s always hidden gotchas lurking that no one really wants to confront.
VeriCycle serves the unique needs of payers and providers, helping both camps turn revenue cycle complexity into faster, more predictable cash flow.
For payers, it’s member frustration and repeat calls that keep executives up at night. Contact center associates forced to toggle across multiple systems results in higher average handle time (AHT).
Providers, meanwhile, are frustrated by slow claim status responses. Hospitals and health systems struggle to stem the flow of revenue leakage tied to coding issues and unresolved appeals.
Here’s how the platform resolves claims right – the first time:
- Vericycle agent assist uses AI to power intent detection
- Shift-Left intervention automation catches eligibility mismatches and conflicts before a claim is built.
- AI denial prevention and appeal generator flags errors pre-submission and drafts evidence-based appeals in 6-8 minutes versus up to two hours.
- VeriCycle insights suite provides real-time dashboards for full revenue cycle management transparency to demystify the black box of accounts receivable.
If you are ready to explore how AI and automation can enhance all healthcare touchpoints, check out these three questions every payer and provider should ask.
