Obtaining pre-authorizations without delay is essential to both preventing unnecessary delays in care and ensuring accurate reimbursement for services provided. But there are multiple challenges to administering an efficient, effective pre-authorization program, including: • Recruiting and retaining staff who have both clinical and revenue cycle expertise • Dedicating resources to stay up to date on complex, evolving guidelines and payer-specific requirements, and to manage payer responses • Lack of a consistent, technology-enabled workflow An Efficient Solution: Our Authorization Management Services staff manages pre-certification and authorization needs for inpatient and outpatient diagnostic and therapeutic services. We also provide comprehensive concurrent or retrospective inpatient authorizations after admission. Our solution includes: • Authorization Experience and Expertise – Our services are provided by clinicians (nurses or allied health depending on client need) who have specialized education in authorization requirements and commercial screening tools. Our team members average more than five years of clinical and authorization experience, stay up to date with training and compliance, and are dedicated to helping ensure that no part of your authorization request slips through the cracks. • A Centralized and Streamlined Technology Process – Our team leverages a centralized system to accelerate payer response, with processes that are efficient and repeatable. We incorporate robotic-process automation to assist with account statuses and system updates. • Thorough Authorization Clinical Review – Our team reviews each medical record, focusing on payer-specific requirements and obtaining authorization for services scheduled or rendered. We stay abreast of changes to Medicare, Medicaid, and commercial payer guidelines. • A Focus on Reducing Authorization-Related Denials – We take a holistic approach to authorization, which includes working auth-related denials. We review denied admissions, days, and services, and complete all necessary steps for reconsideration and appeal requests. Our denial workflow is customized so that we can pair expertise to the type of denial; for example, leveraging technical versus clinical staff depending on the reason for denial. • Detailed Performance Reporting – We provide detailed performance reporting that includes a month-over-month view of account activity including: √ current status √ completion percentages √ approval percentages

Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.

XpertCoding uses advanced AI, NLP, and RPA technologies to automate over 90% of medical coding tasks. XpertCoding's AI-powered coding system maintains a 98% coding accuracy rate, reduces coding costs by over 50%, and processes claims within 24 hours. XpertCoding also includes a Business Intelligence suite with a Clinical Documentation Improvement (CDI) Dashboard and a Comprehensive Data Analytics Dashboard, providing essential insights for healthcare leaders and teams to optimize operations.

What organizations can expect from XpertDox:

Unmatched Automation and Accuracy

• Fully Automated Medical Coding: Automates 94% of claims without human review, ensuring speed, accuracy, and efficiency with minimal supervision.
• Performance-Based Coding: Tracks quality and performance metrics effectively with support for Category II CPT codes.
• Reduces Coding Errors to Less Than 1%: Ensures compliance and minimizes claim denials, delivering precise and consistent coding outcomes with >99% coding accuracy
• Corrects 20% of Erroneous ICDs and 40% Erroneous CPTs for organizations: Improves coding quality and ensures accurate submissions for optimal financial outcomes.
• Faster Claim Processing in less than 24 Hours: Accelerates claim submission timelines, ensuring faster reimbursements and reduced backlogs.
• Smart Claim Scrubber: Customizable to align with payor-specific rules, reducing denials and rejections for smoother claim submissions.
• EMR or EHR-Agnostic Solution: Enables easy data extraction and Fully Automated Claim Submission, ensuring uninterrupted workflows with any EMR or EHR system.
• Modifies and Improves 80% of Claims: Streamlines workflows, eliminating bottlenecks and enhancing operational efficiency.

Enhanced Financial Outcomes for Clients

• Flexible Pricing Model: Offers transparent, per-claim pricing for scalable and cost-effective solutions tailored to your needs.
• Delivers a 15% Increase in Charge Capture: Optimizes revenue generation and ensures accurate billing practices.
• Reduces Claim Denials by 22%: Strengthens the revenue cycle and minimizes payment delays.
• Drives 23% Growth in PMPM Payments: Boosts practice revenue by up to 19%, significantly enhancing financial performance.

Revenue Cycle Optimization and Advanced Insights

• Revenue Cycle Dashboard: Provides real-time visibility into key performance metrics and financial health, empowering data-driven decisions.
• Clinical Documentation Improvement (CDI): Optimizes compliance and documentation accuracy for improved financial outcomes and streamlined workflows.
• Advanced Analytics Suite: Benchmarks provider and clinic performance with actionable insights, helping healthcare teams make informed, strategic decisions.
• Proactively Recovers Missed Charges: Identifies and retrieves overlooked charges from previously submitted claims, enhancing revenue integrity.

Secure and Risk-Free Implementation

• HIPAA-Compliant Infrastructure: Ensures secure data privacy and full regulatory compliance, offering peace of mind for healthcare organizations.
• Risk-Free Implementation: Includes zero upfront fees and a complimentary first month, allowing you to experience the benefits without risk.
• ISO 27001, ISO 22301, SOC2 Type II compliant

Proven Results

• Reduces charge entry lag by 40%, ensuring timely claim submissions. Achieves less than 1% coding errors, significantly improving compliance and reducing denials.
• Enhances efficiency and accuracy, enabling healthcare teams to focus more on delivering high-quality patient care.

XpertCoding by XpertDox

XpertCoding is XpertDox's premier autonomous medical coding platform, designed to accelerate the revenue cycle with unmatched accuracy and efficiency. With risk-free implementation, zero upfront fees, and a complimentary first month, healthcare organizations can experience the transformative benefits of XpertCoding firsthand.

XpertDox is a healthcare technology company committed to reducing administrative burdens for physicians, healthcare teams, and leaders while enhancing patient care through AI-driven solutions. XpertDox employs AI, RPA, and Big Data technologies to improve healthcare outcomes.

XpertDox's commitment to innovation is demonstrated by its flagship product, XpertCoding, an autonomous medical coding software with Clinical Documentation Improvement(CDI) designed to accelerate the revenue cycle by processing medical claims with high accuracy in less than 24 hours.

XpertDox was founded in 2015 and is currently based in Scottsdale, Arizona.

1. XpertCoding is an AI-powered, fully autonomous medical coding solution, whereas EHRs only offer computer-assisted coding that requires provider input and a coding team.
2. XpertCoding provides a Dashboard to monitor claims and perform advanced analytics across all their location, whereas EHRs do not offer a coding-focused Dashboard.
3. XpertDox offers a Clinical Documentation Improvement module not offered by most EHRs.

XpertCoding Differentiators

1. XpertCoding Achieves Automation Rates Exceeding 94%. Far surpassing competitors who typically automate only 60-80% of claims, XpertCoding minimizes manual intervention, ensuring faster and more accurate claim processing.
2. Designed for a Wide Range of Organizations: Unlike most competitors XpertCoding is built to work with RCM organizations, billing companies, small practices, healthcare systems, and hospitals, providing scalable solutions that adapt to the unique needs of any healthcare setup. 
3. Risk-Free Trial with Complimentary Coding Services for One Month: Unlike most competitors, XpertCoding offers a no-cost trial, allowing organizations to experience the platform's capabilities before committing.
4. Rapid Implementation with Minimal Training Time: It requires less than four weeks for onboarding and claim processing, compared to competitors' lengthy timelines, which may span several months or even a year.
5. Comprehensive and Robust Dashboard: Provides real-time monitoring, advanced data analytics, Clinical Documentation Improvement (CDI), payer-specific performance analytics, and a detailed audit trail, empowering healthcare teams with actionable insights.
6. Customizable Smart Claim Scrubber: Tailored to align with payor-specific rules, reducing claim denials and rejections to ensure smoother claim submissions.
7. Seamless Connection Without IT Support: XpertCoding connects easily with any EMR or EHR system and operates without requiring IT support from clients, making implementation hassle-free.
8. Certifications for Security and Compliance: Fully certified for HIPAA, ISO 27001, and SOC 2 Type 2, guaranteeing the highest standards of data privacy and regulatory compliance.
9. ISO 22301 Certified for Business Continuity: Ensures uninterrupted service delivery during disruptions, providing operational resilience unmatched by many competitors.
10. Proactive Charge Recovery and Revenue Optimization: Identifies and retrieves missed charges on previously submitted claims, optimizing revenue integrity. 
11. XpertCoding aligns billing with payor-specific contracts, ensuring precision and compliance.
12. Category II Coding and Value-Based Care Support: Supports Category II CPT codes, enabling organizations to track quality metrics effectively and integrate seamlessly with value-based care frameworks.
13. Optimized for FQHCs and Medicaid Providers: Fully compliant with FQHC requirements and Medicaid coding guidelines, XpertCoding ensures organizations remain compliant while maximizing revenue cycle efficiency.
14. Modifier Support for Enhanced Claim Accuracy: Provides full support for modifiers, ensuring accurate coding for services with special circumstances. 
15. Compared to other competitors in autonomous or AI-assisted coding, XpertDox has demonstrated results across various organization types.
16. Designed to scale for RCM and Billing Companies: Streamlined operations, reduced coding errors, and accelerated claim submissions.
17. Optimal for Mid-to-large scale Practices: Minimal IT requirements and transparent pricing models make XpertCoding an ideal fit for smaller setups.
18. Hospitals and Healthcare Systems: Comprehensive dashboards, charge recovery, and CDI tools support enterprise-level needs.
19. Faster Claim Processing and Reduced Lag: Reduces charge entry lag by 40%, enabling faster claim submission and reimbursement cycles.
20. Improved Accuracy and Compliance: With coding errors reduced to less than 1%, XpertCoding ensures better compliance and fewer denials.