Case Study: a payer client achieves improved DRG savings with EXL analytics-driven clinical auditing

Payer Client boosts DRG savings 56% with EXL

The customer, a payer client, sought to streamline its payment integrity program, specifically its Diagnosis-Related Group (DRG) auditing, which was hindered by an inefficient process involving eight different vendors. EXL, serving as their trusted post-pay DRG clinical auditing vendor, was approached to reduce this administrative burden and operational workload.

EXL implemented a fully outsourced, analytics-driven solution, overhauling the audit approach by investing heavily in analytics to review the entire claim lifecycle and identify new audit areas. This EXL solution yielded an improved savings rate of 120%, delivering 30% overall DRG savings in 2020 and 56% in 2021, along with improved resource efficiency from streamlining to a singular vendor.