Health IT

Medical claim analytics startup sees role to smooth out chaos in upcoming coding explosion (video)

Medical Billing - Insurance ClaimsAfter numerous delays, the healthcare industry is getting ready to implement the 10th revision of the International Statistical Classification of Diseases and Related Health Problems in 2014, aka ICD-10. Some healthcare IT companies sense a big opportunity to help payers and providers through a process of implementing what will be thousands of new codes. Although it’s supposed to improve fraud detection, improve reporting and provide more accurate reimbursement, some have compared the concerns surrounding the implementation process to a Y2K for healthcare.

Medical claim analytics startup Advance Response has carved a niche for itself by providing follow-up support for medical billing issues. It believes it will provide a useful service to help manage the messiness the approaching implementation will produce for some groups.

The Sea Girt, New Jersey-based company estimates that of the 3 billion claims submitted annually, about 20 percent or 600 million require some follow up, adding up to a market opportunity for the company of up to $9 billion. The healthcare IT startup with a cloud-based multichannel claim analytics platform sees plenty of opportunity to accelerate the claims resolution process.

In making a case for its company before a roomful of investors at the Angel Venture Forum in Washington, D.C. this week, Ken Poray, Advance Response CEO, said hospitals are giving more and more follow-up work away to companies less and less qualified to do it. He said his clients include one of the largest payers in the country. It has also been successful at turning potential competitors, particularly third-party software vendors, into partners.


In the past year it has shifted from a working prototype to a commercial product that’s scalable, Poray told MedCity News. “We’ve done a complete build-out of an integrated platform that sits between payers and hospitals to speed up claims resolution,” Poray added. “We have also been able to hire key technical resources to meet our current pipeline and look forward to hiring additional staff in 2013 to meet demand.”



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