The Challenge
This specialist clinic was processing 40% of patients through CNAM (national health insurance), but claim rejection rates of 38% meant significant revenue was left unclaimed. The manual claim preparation process took 3 full-time administrative staff, with frequent errors and delayed processing.
The Solution
COA implemented its CNAM Integration Gateway alongside clinical documentation and billing modules. All consultation codes, procedure codes, and diagnostic codes are automatically mapped to CNAM requirements. Claims are generated automatically and submitted digitally.
The Results
Claim acceptance rates rose from 62% to 94% within 8 weeks of CNAM integration. The 3 administrative staff previously dedicated to manual claims preparation were reassigned to patient services, and claim processing time fell from 14 days to 2 days.
“Our rejection rate went from 38% to 6%. We recovered months of backlogged claims and now process new claims in 2 days. The ROI paid for the entire system in 4 months.”
Key Outcomes
- Automated CNAM code mapping eliminates manual procedure coding errors
- Digital claim submission replaces paper-based process
- Real-time eligibility verification prevents claim rejections at point of service
- Claim status tracking provides full visibility into outstanding insurance receivables
- Administrative staff reassigned from claims to patient services
- Historical rejected claims recovered through automated retroactive resubmission