Case Study: a health plan achieves clean claims targets with Zymr's large-scale RCM validation

A health plan achieves 97.2% first-pass claims acceptance with Zymr

The customer, a large health plan serving 2.8 million members, faced the challenge of achieving a 96% clean claims target. Their revenue performance depended on navigating complex payer rules and EDI formats, but errors risked delayed reimbursements and revenue leakage. To de-risk the deployment of new RCM logic, the health plan partnered with vendor Zymr for large-scale testing and compliance validation.

Zymr implemented a comprehensive RCM testing and assurance program, which included validating EDI transactions, testing denial prediction models, and simulating 1.9 million claims. The solution ensured real-world accuracy and strengthened the platform's security and compliance posture. As a result, the health plan achieved a 97.2% first-pass claims acceptance rate, a 22% improvement in accounts receivable recovery, and reduced its days sales outstanding to 38 days.