Case Study: AI Technology for Itemized Bill Review Optimization

Sep 8, 2023

A multi-state health plan engaged TREND Health Partners to increase their volume of itemized bill reviews, and by leveraging TREND’s medical review technology, CAVO®, increased their total financial value by 61% after 18 months.

When the payer initially engaged with TREND, their ten full-time team members manually reviewed 7,500 claims annually. After implementing CAVO into their workflow, reviewers no longer had to transcribe denied line items into spreadsheets, reducing time spent and internal program resource costs. Additionally, layering CAVO’s AI capabilities onto the workflow further increased team productivity by introducing predictive models that reviewed and suggested prioritization of denied line items.

61% increase

in total program financial value (+$14 MM)

Throughput increased 97.3%

from 3 to 5.9

Costs reduced by 25%

Internal program resource costs reduced by 25%

After utilizing CAVO technology for 18 months, the payer’s internal team nearly doubled their daily reviews per user from 3 to 5.92, a 97.3% increase. Compared to post-pay reviews, the payer’s team increased their total percentage of pre-pay reviews from 44% to 81% over eighteen months while still finding value in post-pay. Additionally, the team maintained a 90% hit rate for total claims reviewed and reduced the appeal rate by 1% despite the increase in review volume.