EVP of M&A, Integration & Value Improvement Projects, eviCore
eviCore Healthcare specializes in assessing patient cases to ensure that the clinical procedures ordered by their healthcare providers are eligible for benefits and quickly pre-approved. This process requires reviewing high volumes of information, ranging from patient records and details on medical procedures, to insurance provider requirements and CPT codes. With a growing client base, eviCore wanted to scale its business without significantly increasing the workload of nurses and doctors who review cases or slowing down approval cycle times for patients and providers. The company zeroed in on advanced analytics as a way to support decision-makers and speed the benefits approval process.
eviCore needed an advanced analytics solution that, with minimal IT involvement, could quickly process large volumes of available data and push actionable insights to the decision-makers reviewing claims. With Chorus, data analyst teams can quickly capture end-user requirements, process their data, construct models, and deploy their models into production in a matter of weeks. Previously, the data processing step alone would take several months, and required specialized data science and IT resources to complete.
eviCore was able to easily and efficiently deploy predictive models in Chorus that leverage patient, procedure and insurance data to speed up the pre-approval of incoming claims. These models enable eviCore to score claims based on the likelihood of their being either approved or denied, and, most importantly, to operationalize these predictions at the point of action.