Health Systems: Access, RCM & HIM at Scale
Centralize patient access, standardize auths/case build, and run coding QA, claims, AR/denials with system-wide definitions & QA.
Why Carenox for Health Systems
Multi-facility complexity needs tight definitions and change control. We lock SLAs/QA with exemplars, and keep dashboards aligned across facilities.
- Case build & auth variants by service line
- Revenue integrity checks & HIM coordination
- Denial prevention pathways with owners
- System-level dashboards with drill-downs
Core Lanes
- Patient Access & Scheduling
- Eligibility/Benefits & Estimates
- Prior Auth & Case Build
- Utilization Review handoffs
- Coding QA & Revenue Integrity
- Claim Edit/ Scrub & Rejections
- Payment Posting & Refunds
- AR Follow-up & Denials
- HIM coordination & documentation integrity
- Appeal templates with evidence
- Definition locks & dashboard catalog
- Change control & training attestations
Operating Model
- Define SLAs/QA per lane & service line
- Versioned SOPs & macros; exception flows
- Pods, cross-training, calibration cadence
- System dashboards with drill-to-evidence
- QBRs & continuous improvement
Key KPIs
- Auth TAT/approval, LOS impact
- DNFB, AR aging & denial win-rate
- Coding QA pass rate & rework
- Appeal hit rate & cycle time
Recent Outcomes
Access & Auths
Auth TAT −29%; DOS cancels −37%; approval +6.8 pts.
Revenue Integrity
DNFB −22%; preventable denials −24%.
AR & Denials
>90d AR −17%; appeal win +10.9 pts.
Ready to standardize across facilities?
We’ll scope lanes and align SLAs/QA with system dashboards.
