Modernizing Revenue Cycle and Claims Management

Deploying the latest technologies to help Health IT Vendors, Providers, and Health Plans improve RCM and Claims Management.

Revenue Cycle Management for Healthcare

Elevate your RCM or Claims Management Capabilities

Submitting and paying claims is the financial underpinning of the U.S. healthcare system and shapes every other aspect of the industry. An efficient billing function protects margins while leveraging claims data and workflows to drive other institutional priorities.

However, RCM and claims workflows are full of manual processes and are reliant on ossified systems that slow innovation. 3Pillar’s team of product managers, designers, and engineers will partner with your team to modernize your systems and accelerate the implementation of your digital health strategy.

7 Opportunities to Streamline the Payment Ecosystem

Healthcare organizations can leverage AI, robotic process automation, and low-code/no-code tools to address well-known break-points.

Based on our extensive work in RCM and claims management, 3Pillar has identified the following opportunities to leverage modern technology:

Provider Opportunities

1 Recreate the health plan algorithm:

Automate manual processes and leverage AI to better understand claims requirements and medical policies.

2 Provide real-time coding assistance:

Leverage a robotic-process automation-based rules engine to flag expected documentation issues.

3 Engage patients up front:

Build better user experiences with digital check-in, more effective use of eligibility data, and point-of-service payment collections.

Health IT Vendor Opportunities

4 Create interoperable, efficient work streams across EMRs:

Use modern APIs for timely access to data residing in various systems to standardize data to build or operate efficient solutions.

5 Create open platform RCM architecture:

Elevate the role of RCM by creating open architecture that healthcare organizations can leverage to integrate data and workflows to support other organization goals.

Health Plan Opportunities

6 Serve as a member financial concierge:

Develop digital, personalized campaigns to engage members and help them proactively understand the costs of care.

7 Reduce provider abrasion:

Ease provider frustration and make your network more appealing with faster process claims and prior auth request processing times and upfront, transparent claim submission guidelines.

Revenue Cycle Playbook
The Revenue Cycle Playbook:
7 Opportunities to Modernize the Healthcare Payment Ecosystem
Download Now

Who We Help

Providers

  • Integrate RCM into customer and clinical workflows
  • Provide real-time coding assistance
  • Automate review of claims to reduce denials
  • Streamline RCM vendor integrations

Health IT Vendors

  • Recreate health plan denial logic
  • Integrate your solution across multiple EMRs
  • Automate manual internal processes
  • Build new product functionality

Health Plans

  • Modernize claims management systems
  • Provide real-time prior-authorization support
  • Ensure payment integrity
  • Improve member and employer experience

RCM & Claims Experience

Helping a Home Health TPA Automate Their Authorization and Claims Adjudication Process

A traditional home health TPA sought to automate their authorization and claims adjudication process, driving efficiencies and increasing accuracy in their revenue cycle management operations. 3Pillar developed a business rules engine that helped them double their claims processing capacity.

Read More

Leading a Lab Tech Company to the Benefits of Robotic Process Automation and Digital Solutions

3Pillar collaborated with the company to build an end-to-end clinical workflow management platform using Robotic Process Automation to rapidly accelerate payment processing.

Read More

Positively Impacting the Digital Experience for a Fortune 50 Healthcare Company’s Customers

3Pillar provided a leading MCO’s customers with an end-to-end online experience that makes the highly complex, regulated process of managing one’s own healthcare simple.

Read More

Harnessing Data to Help a Community Healthcare Organization Drive a New Standard of Care

3Pillar recently helped a leading healthcare provider improve interoperability of disparate patient data from different EHR systems to create one cohesive dataset that informs Medicare and Medicaid population health solutions.

Read More

How We Help

Strategy & Consulting

Understand the current state of your software, identify risks, and plan needed development + technology strategy to achieve your business goals.

Product Engineering

Build, scale, automate, or modernize your digital products. Create high-value digital experiences for customers and efficient, integrated internal workflows for employees.

Data Engineering

Ground all applications, workflows, and decision making in a strong data foundation and real-time, high-quality insights.

Artificial Intelligence

Leverage AI to digitize data, generate insights, and give coders, clinicians, and patients real-time, contextual decision support.

Revenue Cycle Playbook
The Revenue Cycle Playbook:
7 Opportunities to Modernize the Healthcare Payment Ecosystem
Download Now

Our Thoughts

Revenue Cycle Playbook
The Revenue Cycle Playbook:
7 Opportunities to Modernize the Healthcare Payment Ecosystem
Download Now