Reading Time: 6 minutes
Financial Impact: Evidence provided to negotiate a $1M risk-sharing savings

After signing a Value-Based Care (VBC) contract with Anthem, a statewide OB practice was blindsided by a $1.3 million downside risk penalty, with no way to validate the payer’s claims. Anthem presented its cost calculations as final only in summary form, likely assuming the practice lacked the tools to analyze the data. Without RevOps Health, the practice would have been forced to either accept the charge or engage in an unstructured, “he said, she said” debate. Using advanced search capabilities and financial modeling, they extracted visit data, applied payer exclusions, and benchmarked costs against medical inflation. Armed with clear evidence, the practice countered Anthem’s assertions, proving that cost increases were primarily facility-driven and outside their control—leading to a major reduction in financial liability.

Reading Time: 5 minutes
Financial Impact: Recovered $1.5 million in denied claims.

A healthcare provider identified and resolved a surge in preauthorization mismatch denials. Analysis with RevOps data visualization tools enabled cross-functional collaboration and systemic corrections, improving workflows and recovering $1.5 million.

Reading Time: 5 minutes
Financial Impact: Recovered $1 million in underpayments.

A healthcare organization uncovered over $1 million in underpayments caused by a payer misapplying reimbursement rates for eating disorder claims. OpsRadar provided evidence for successful payer negotiations and established annual audit protocols to ensure compliance with updated rates.

Reading Time: 3 minutes 
Financial Impact: Recovered $85,260 in unpaid claims.

An urgent care network struggled to reconcile a clean billing report with no denials as provided by their biller on COVID-19 testing and revenue that fell short of expectations for the business line.

Reading Time: 4 minutes
Financial Impact: Improved contracted rates and ensured payer compliance with new agreements.

Two independent practices used OpsRadar to secure higher reimbursement rates by presenting data-driven evidence of underpayments. Post-contract, automated monitoring ensured payers adhered to the new rates, streamlining negotiations and enforcing accountability.

Reading Time: 4 minutes
Financial Impact: Potential recovery of $500,000 in unpaid claims.

A healthcare system identified a $500,000 shortfall in a payer's reprocessing performance for a single states facility. Detailed analytics revealed regional discrepancies, prompting corrective actions and ensuring payer accountability.