Avoidable Claims Denials and the Road to Payer/Provider Collaboration — ICYMI

Optum’s John Campbell discusses current challenges for state governments managing avoidable claim denials, the impact on Medicaid providers, and practical strategies for states to proactively improve the process.

April 10, 2023 •

THIS WEEK’S STORIES

The estimated annual administrative cost of health care has eclipsed $1.1 trillion, according to a report from Optum. Recent studies peg nearly 25 percent of these costs as coming from clinical and administrative waste due to a lack of transparency between payers and providers which results in improper denials.

Medicaid in particular experiences a higher percentage of initial claims denials — 25 percent, as opposed to 7.3 percent for Medicare and 4.8 percent for commercial providers — and the percentage of provider revenue loss due to denials is also higher for Medicaid providers (17.4 percent) than Medicare (5 percent) or commercial providers (2.8 percent). There is a direct, causal link between claim denial rates and Medicaid provider enrollment.

John Campbell, former director of Medicaid enterprise systems for the Utah Department of Technology Services and now director of product management for Optum State Government Solutions, joins Dustin and Joe on this episode of ICYMI to discuss the ongoing challenges for state governments and providers in managing avoidable claims denials. Campbell also provides examples of how technology is being leveraged to modernize the claims process and recommends ways the public sector can address the issue as a priority.

LEARN MORE

Visit Optum to learn more about their solution
Connect with John Campbell on LinkedIn

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Dustin Haisler

Dustin Haisler is the president of Government Technology's parent company e.Republic. Previously the finance director and later CIO for Manor, Texas, a small city outside Austin, Haisler quickly built a track record and reputation as an early innovator in civic tech. As President, Haisler drives exponential growth, implements new ideas and promotes a corporate culture that rewards creativity. Read his full bio.

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Joe Morris

Joseph Morris is the chief innovation officer of <i>Government Technology</i>’s parent company e.Republic and a national keynote speaker on issues, trends and drivers impacting state and local government and education. He has authored publications and reports on funding streams, technology investment areas and public-sector priorities, and has led roundtables, projects and initiatives focused on issues within the public sector. Joe has conducted state and local government research with e.Republic since 2007 and knows the ins and outs of government on all levels. He received his Bachelor of Arts in government and international relations from the California State University, Sacramento.

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