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Revenue Integrity Services

Technology-driven processes to optimize your healthcare organization’s revenue integrity

Revenue Integrity Services Overview

With over 29 years of industry and revenue integrity experience guiding our team of experts, Exela Technologies is at the forefront of identifying and correcting unrecognized, unrealized revenue for healthcare providers.

With a 98.6% recovery success rate, Exela’s processes and technology increase the bottom line by 2%-5% of net patient service revenue by eliminating false positive variances and reducing in-house staff expenditures. Exela has recovered billions for our provider clients.

Exela’s comprehensive approach enables revenue integrity through integrated solutions addressing the entire revenue and reimbursement lifecycle. Our services include Contract Management, Underpayment Identification and Recovery, Contract Modeling, Contractual Allowance Shadowing, Denials Management, and Data Mining, Analytics and Reporting.

Average 2%-5%

unrecognized revenue

Billions

recovered for our provider customers

98.6%

recovery success rate

Contract Management

Contract Management

Transform contract documents into fully digital assets for efficient data extraction and downstream automation. Load and maintain all third party payer contractual agreements for easy access and integration with revenue integrity initiatives.

Denials Management

Denials Management

Exela has developed a comprehensive denials management system that streamlines every step in the process, from intake to appeals, to trend identification - all to maximize operational efficiencies and optimize reimbursements.

Underpayment Services

Underpayment Services

Retrospective analysis helps recoup missing funds from up to 2 years prior, while daily concurrent review identifies unrecognized revenue on a daily basis. Our services include root cause analysis ensuring ongoing payment and preventing revenue leakage in real time.

Data Mining and Analytics

Data Mining and Analytics

Our proprietary technology platform stores all information contained within the 837, 835, and contractual agreements for easy search and retrieval while providing unlimited query and reporting capabilities to find exactly what you’re looking for.

Predictive Contract Modeling and Benchmarking

Predictive Contract Modeling and Benchmarking

Receive accurate reimbursement calculations for current and future contractual agreements with multiple scenarios using the most recent one-year patient data set, arriving at the net dollar and percentage increase or decrease.

Contractual Allowance Shadowing

Contractual Allowance Shadowing

A key component to a successful analysis begins with calculating the correct expected reimbursement and contractual allowance for all third party payer claims. Exela’s third-party payer calculation engine and adjudication system calculates, compares and corrects the client’s expected reimbursement and contractual allowances daily, at the time of final billing. Exela’s services complement, supplement, and or replace existing processes.