Perry: Cluster Denied Claims to Extract Rules Instead of Calling Payers
Nick Perry · Ep 73: Lessons from Palantir & How Candid Health Is Fixing the $280B Healthcare Billing Fiasco · Joe Lonsdale · Dec 7, 2023 · at 7:22
Nick Perry, co-founder and CEO of Candid Health, outlines Candid's approach to automating healthcare billing and reducing administrative friction.
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“Cluster your claims. Find which ones were denied for the same reason. Make one call. Don't call for all thousand of the ones were denied. That's smart. Take that rule, put it in the rules engine, and don't make that mistake anymore.”
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More from Nick Perry
Perry: Most Surprise Medical Bills Stem From Provider Submission Errors
“In most of those cases, the provider submitted the claim wrong.”
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.”
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.”
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.”
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.”
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…”