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Insurance Discovery Solutions

Identify hard-to-find health insurance coverage to maximize reimbursements

Capture more revenue with smarter insurance coverage discovery

Identify more billable insurance coverage from third-party payers that others vendors miss. Find up to .5% more coverage by looking beyond self-pay accounts at potential coordination of benefits opportunities and Medicaid secondary to maximize reimbursements. After developing the first holistic insurance discovery solution more than 15 years ago, we haven’t stopped innovating and enhancing our technology to deliver the very best to the industry.

Get an insurance discovery solution tailored to your business

Maximize reimbursements from uncompensated care and underpaid accounts. TransUnion Healthcare’s market-leading methodologies scale to meet all insurance discovery needs, including complex cases involving multiple commercial and government payers. Our insurance coverage discovery solutions explore all possible avenues to identify hard-to-find coverage from third-party payers — resulting in a healthier bottom line.

Hospitals and health systems

Our robust insurance discovery platform helps identify incomplete, inaccurate or missing patient data to find maximum coverage for hospitals and health systems. This scalable offering delivers automated, customizable reports that identify billable government and commercial coverage.

Through built-in revenue cycle analytics, we find and prioritize black hole accounts, track KPIs for improved staff management and help reduce A/R days. These analytics are delivered directly through an interactive dashboard.

This insurance discovery solution can convert 1 – 5% of a hospital’s uncompensated care accounts.

Our insurance coverage discovery solution for hospitals and health systems:

  • Continuously looks for coverage on all accounts (not just self-pay)
  • Finds additional payment opportunities from complex cases including Medicaid secondary and potential coordination of benefits opportunities
  • Identifies commercial policy ID numbers for patients believed to be uninsured
  • Monitors Medicare and Medicaid for retroactive SSI certification
  • Offers a contingency-based payment structure — we don’t get paid until your revenue is recovered

This solution has industry-backed validation — it’s HITRUST CSF® certified, KLAS© reviewed and HFMA© Peer Reviewed1.

LEARN MORE ABOUT OUR SOLUTION FOR HOSPITALS AND HEALTH SYSTEMS >

Ambulatory and physician practices

Maintaining complete and accurate demographic and insurance benefit information for patients — especially with EMTALA — can be a challenge, which can lead to lost revenue. Our insurance discovery solution identifies money owed to you from third-party payers by providing you with quick coverage results. This means less process disruption and strain on staff.

On average, our insurance discovery solution for ambulatory converts 5 – 7% of uncompensated care accounts to Medicaid, Medicare and/or Commercial insurance.

This insurance discovery solution is able to:

  • Correct patient demographic discrepancies to identify coverage for patients believed to be uninsured
  • Run all accounts against the Medicare Common Working File and state Medicaid databases
  • Deliver commercial coverage
  • Do quick batch processing to discover and bill missed eligibility prior to manual collection efforts

TO LEARN MORE ABOUT OUR SOLUTIONS FOR AMBULATORY CARE FACILITIES AND PHYSICIAN PRACTICES, CONTACT US >

Academic medical centers (AMCs)

AMCs see large volumes of complex, high-dollar medical claims which can be at greater risk for lost revenue. Our Revenue Assurance solution — specifically customized for AMCs — goes beyond traditional insurance discovery to address complex billing issues head on and obtain the hardest-to-reach revenue. Through a combination of market-leading proprietary software and expert knowledge of billing processes, regulations and the revenue cycle, we won’t stop searching for additional payment opportunities until all avenues have been thoroughly reviewed.

Nearly two decades of extensive billing, regulatory and patient accounting system expertise for AMCs.

Revenue Assurance helps AMCs improve their net revenue:

  • Ensure accurate billing by discovering incorrect payer and/or policy numbers
  • Convert self-pay accounts to an insured status
  • Protect at-risk revenue and cash, including accounts nearing timely filing limits
  • Find and recover underpayments across various accounts

Healthcare partners and resellers

Healthcare providers miss reimbursement opportunities due to complexities in verification and post-service processes. Emergency department visits, an unscheduled EMTALA setting, can further complicate the verification process. With TransUnion Healthcare’s streamlined, batch insurance discovery solution, you can offer your provider clients quick, accurate insurance coverage results to help:

  • Decrease uncompensated care and collection costs
  • Identify coverage even when demographics don’t match
  • Find missed coverage for all third-party payer types

5 – 7% of all uncompensated care accounts have billable third-party coverage unknown to the provider or its vendors.

LEARN MORE ABOUT OUR INSURANCE DISCOVERY SOLUTION FOR HEALTHCARE PARTNERS AND RESELLERS >

Work with a market leader

Accredations

eScan Insurance Discovery
eScan Insurance Discovery
eScan Insurance Discovery

1HFMA staff and volunteers determined that this product met specific criteria developed under the HFMA Peer Review process. HFMA does not endorse or guaranty the use of these products.

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