Case Study: National Independent Physician Organization reduces underpayments with EXL Health and REVELOHEALTH

EXL Health and REVELOHEALTH close provider services agreement with national practice

A national independent physician organization hired EXL Health and REVELOHEALTH after discovering they were potentially being underpaid by a large Medicare Advantage payer. Their challenge was to validate these underpayment claims and identify the complex payer behavior causing them, as their standard practice management system was unable to detect these issues.

The solution involved implementing REVELOHEALTH’s OneCareCost platform, a claims repricing system that uses payer technology to model complex contract rules. The analysis revealed that while the payer was mostly correct, they had implemented contractual adjustments, such as changing geographic designations that reduced reimbursements by an average of 30% for many codes. This partnership provided the organization with the insight to take proactive, corrective actions and is being expanded to cover all their payer contracts.