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How providers are using purpose-built automation to do less manual work and still get more (and better) benefit rules coverage, and therefore estimation accuracyĮxamples of provider use-cases with results Why eligibility is no longer a commodity and what providers must have to ensure eligibility is accurate It’s not surprising that front-end staff sometimes get it wrong. Eligibility is based on specific benefit levels (i.e., copays, coinsurance), in- and out-of-network determination, authorization and deductible/out of pocket information for a specific care episode. Today, it’s not just about whether a patient has coverage. What’s more, each payer approaches this differently despite established standards-based bodies like CAQH. Payers have shifted much of the member experience and relevant benefit information to online payer portals, which leaves providers to rely on disjointed sources of information and outdated EDI solutions. In addition to patients changing plans, payers are continually updating member rosters and benefit databases.
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Furthermore, as employees change jobs at a record pace and float in and out of exchanges, it's easy to see why accurate eligibility verification remains elusive for many providers. Endplate conforming cages provided comparable clinical results and fusion rates in comparison to the traditional cage but with decreased postoperative subsidence and a lower severity of subsidence-related neck pain in follow-up.Įach year, approximately 45 percent of Americans plan to change their coverage level, which has a cascading effect on their benefits, in- and out-of-network options and transparency into their patient financial responsibility.Īll of these changes expose healthcare providers to potential front-end errors that can ultimately result in higher denial risk or non-payment from patients. Compared to non-personalized cage designs, personalized interbody cages reduced endplate stress, increased contact area for bone graft loading, lowered stress on posterior rods and caused a lower stress increase on adjacent levels.ģ. Personalized geometry and fit may help surgeons more reliably achieve optimal alignment, which is the most significant predictor of improved clinical outcomes in surgery to correct spinal malalignment.Ģ. Over 30 studies describe the benefits related to personalized geometry and endplate fit, which may help surgeons achieve sagittal and coronal alignment goals more reliably.ġ. The Rationale for Personalized Interbody Devices is a literature review of published research about the potential benefits of patient specific interbody devices. adults seek treatment for spinal deformities every year.
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