Headquartered in Brooklyn, New York, Elderplan is a well-established, not-for-profit health plan organization. This case study details how Elderplan leveraged HealthRules Payor to maximizes their operational efficiency and control administrative costs while embracing an evolving business model. The end of 2019 into 2020 also posed a unique and new challenge for Elderplan – serving members living in the epicenter of the COVID-19 pandemic, NYC. Elderplan needed to nimbly react to evolving regulatory requirements to remain compliant and continue to serve their members and providers quickly and accurately.
In this case study you will learn:
- The challenges faced by Elderplan in maximizing operational efficiency to process Medicare claims
- How HealthRules Payor enabled Elderplan to achieve a 92.5% auto-adjudication rate and reduce the number of consultants utilized for claims processing
- How Elderplan dramatically reduced the claims inventory for review
- How Elderplan responded to the COVID-19 pandemic
Read the case study to learn how Elderplan is realizing significant benefits from the use of HealthRules Payor.