Solutions

We use our proprietary technology as the foundation to offer a wide array of solutions that include user-facing products, automation products that run in the background, data as any service (DaaS), data-enhancements, system integrations, and revenue cycle and payment optimization advisory services. Our goal is to meet our clients wherever they need us to be on their revenue cycle journey.

 

Switch Underpayment Detection System

Opportunity Identification with Machine Learning

The Underpayment Detection System platform is capable of parsing, storing and analyzing every data element on an ANSI standard transaction at a rate of over 3000 physician claims (837P/I or 835) per second. Claim and remittance data is then analyzed against a set of business rules to quickly and automatically identify opportunities to recover at-risk revenue. The Underpayment Detection System also compiles data into customizable outputs sufficient for creating bulk appeals based on the data elements that your payors may request. In addition to finding underpayments, the Underpayment Detection System also tracks total recoveries and percentage of appeals successfully recovered. ​

Switch provides a risk-free analysis of payment data using the Underpayment Detection System to healthcare providers. We then present you with the opportunities that we believe exist for recovery and allow you decide what to pursue.

The Switch Underpayment Detection System may be the fastest way available to get from start of engagement to realizing hard ROI. This is the kind of revenue recovery opportunity that can provide a big boost to healthcare organizations dealing with the impact of COVID-19 with very little lift for your organization. All we need to get started are 837s and 835s (contracts and fee schedules help a lot, too). If we have a relationship with or can establish a relationship with your clearinghouse, we can get 837 and 835 data directly from them to fully remove IT lift for your organization.​

 

Switch Perspectives

Analytics & Business Decision Support Suite

Switch Perspectives is a collection of revenue cycle and financial reporting applications that are available via our web portal 24/7/365 in our HIPAA-compliant cloud. Reports are available on any device, including smart phones and tablets. Process, search and get data on hundreds of data points from millions of records in a matter of seconds. Switch Perspectives currently encompasses the following applications:

  • Billing Perspective

    • Current AR and active historical charges

    • Denial management

    • Charge review management

  • Claims Perspective

    • Historical claim and charge data with AR

    • Denial management

    • Charge review management

  • Financial Perspective

    • Historical charge, payment and adjustment reporting in a ledger-like format

    • Reporting consistency between Rev Cycle and Finance

  • Contracts Perspective

    • Full featured Contract Management System

    • Under pay and under charge identification

    • Contract modeling

 

RateKeeper

Build & Maintenance Automation

  • Fee Schedule Builder

    • Why take chances on undercharging, when it is the most preventable form of physician billing revenue leakage​

    • Our process can build and maintain fee schedules in your billing system, so you never have to worry about another undercharge

  • Contract Builder

    • It is more important than ever to have your contract terms built directly into your core billing system. Contract rates help power workflows and provide accurate data for underpayment analysis, patient payment estimates and more​

    • Contract Builder ports the contract terms built into the Switch Contract Management System (SCMS) and automatically builds those same terms in your billing system's contract module, through a simple file upload

 

Revenue Cycle Compliance Pro

Physician Audit Workflow & Reporting

Rev Cycle Compliance Pro is a full featured audit workflow and reporting application for audit and compliance professionals for physician billing:

  • Audits E&M codes for providers in the organization

  • Automatically levels E&Ms based on Medicare criteria

  • Allows scheduling of groups of providers for future audits

  • Performance dashboard on both providers and auditors

  • Risk profile allowing comparison of provider against specialty, organization, locally or nationally

  • Tracking new provider education

 

Switch RPA (Robotic Process Automation)

RPA Suite

SRPA is a group of services that automate processes and workflows in your core billing system. The SRPA services currently include:​​​

  • Secondary Balance Resolution

    • Switch calculates allowed amounts for both primary and secondary payors

    • We deliver back expected primary payment amounts and/or secondary allowed amounts in a way that the balances can be automatically resolved in your billing system on items for which you do not to expect additional money from the secondary payor

  • Enhanced Claim Status​

    • There are variations in how payors provide status for claims that are in-process, pended for more information or investigation, and those awaiting a remittance adjudication cycle

    • We understand the processing and payment timelines, as well as the different code combinations that the individual payors use and we normalize and classify status transactions into our own proprietary status grouping to ensure that claims are appropriately classified no matter which payor is billed

    • We can also pass back claim status updates at both the claim and charge level, to automate claim acceptance, the routing of rejected claims to staff and prioritization and automation of work

  • Work Prioritization

    • We use proprietary algorithms to determine the collection opportunity, the true cost to collect, and likelihood to collect

    • We score and categorize charges, claims and/or accounts so that you can drive actions like routing work to specific staff members or automatically resolving balances you are unlikely to collect or a balance that would cost more to collect than the amount that could be collected

 

Switch Data Service

Data as any Service

At Switch we understand that the data needs of organizations vary greatly. Many organizations have internal reporting teams and a specific BI tool (Qlik Sense, Tableau, Microsoft BI, etc.) and just need help integrating external data from sources like payers and clearinghouses. Other organizations prefer to have their data available in an out of the box cloud-based analytics tools. And many organizations need data to be transformed and used for industry standard transactions like eligibility (270/271), claim status (276/277), institutional claims (837I), professional claims (837P) and electronic remittance advice (835). We offer data services to fit these services and many more, including highly customized applications and data transformations.

 

IntegrEDI

EDI Validation

Whether you are testing a new EDI system or a direct submitting EDI transactions to payers, we can provide the assurance that your files are valid. In addition to overall file validity checking, we check for missing required or situationally required data, and also check the validity of values within each data element of an EDI file. Our validation service works on all ASC X12 and all finalized/adopted versions.

 

While we are primarily focused on providing services to healthcare provider organizations, this product works on any ASC X12 transaction and therefore we offer it as a service to users of these standard transactions regardless of industry.

 

Switch Engage

Advisory Services

Switch Engage is not a consulting firm in the traditional sense. We do however offer advisory services as an extension of our products. Switch Engage provides opportunities for our clients to bring us in for targeted project work that is beyond the scope of normal account management that focus on Revenue Cycle and Payment Optimization. We use data analytics to create the foundation for evaluating workflows, services offerings, staffing ratios and targets, staff efficiency, staff quality, business operations approach, or business strategies.

Example Engage projects

  • Find out how your pricing methodology compares to other providers in your market and whether a different pricing methodology may work to make your organization more attractive to shopper patients who have choice in where they go for services

  • Determine how you can increase your clean paid claim rate by finding opportunities to reduce denials, claim edits and unnecessary charge review

  • Evaluate staff production relative to business volume and determine where opportunities exist to meet or exceed industry benchmarks

  • Create a program for automating the measurement of staff work quality and use that to create an overall staff quality rating