Nick Perry, co-founder and CEO of Candid Health, discusses the root causes of unexpected patient medical bills with Joe Lonsdale.
Assertion Not checkable as stated
Perry: Major US Health Insurer Manually Processes One in Eight Claims
“Yeah, actually, I know there's a large payer, ah, that I know manually processes one in eight claims because their adjudication system doesn't do it. It's a large payer. We'd all know the name of it.”
Assertion Not checkable as stated
Perry: Candid Was First to Catch a Major Health Payer's Bug
“We were the first company in the country to identify that this very large payer had put a bug into their rule system. And they fixed the bug based on, like, us pointing out, hey, you guys, something seems to have happened here.”
Assertion Not checkable as stated
Perry: Most Medical Billing Companies Ignore Touchless Claim Rates and Automation
“Most billing companies do not do that number because they don't care about automation. They care about first pass resolution, but we wanted first pass resolution where no manual steps were taken.”
Insight
Perry: US Healthcare Standardized Forms but Not Field Requirements
“They didn't, they standardized the form. But they did not standardize the field, what you put in each field in the form.”
Opinion
Perry: Medical Billing Remains Manual Because Industry Lacks Good Software
“Why this is so expensive, so manual is because there's no good software today. People have to do this by memory or they're like, Creating their own rules or they're like doing things. They're hand jamming. There's a lot of manual work to actually try to do all…”
Prediction Not checkable as stated
Perry: Candid Health Can Sell Its Pre-Adjudication Engine Back to Payers
“I 100% think we could because if you think about what we're doing, we're pre-adjudicating the claim. We know how the payer's, we know what the payer wants on their claims. We know, like, what their rules are for how to submit a claim. And there's a bunch of no…”