Confirming the Accuracy of Healthcare Technology Solution, seeQer: Part 2

careviso collaborated with a national genetic testing laboratory and a prominent children's hospital to confirm the success and accuracy of healthcare transparency platform, seeQer, versus real claims data received from health plans. seeQer proved to be highly effective in predicting patient out-of-pocket cost and administrative requirements. Download the white paper for the full breakdown. This is part two of three of our series in which we compare seeQer to the claim.

Confirming the Accuracy of Healthcare Technology Solution, seeQer

SERIES - PART 2 : Collaborating with a national lab offering genetic testing & a prominent children’s hospital

Introducing seeQer, a Healthcare Technology Platform by careviso

Innovating to make healthcare price transparency a reality

As per a survey performed by careviso, financial transparency and prior authorizations are some of the most prevalent issues in U.S. healthcare.

• 80% of patients avoided medical care due to pricing or insurance concerns.
• 90% of patients said prior authorizations issues negatively affected their healthcare experience in the past year.

Healthcare technology company, careviso, was founded in 2017 with the goal of improving patient access to healthcare. careviso is partnered with over 300,000 healthcare providers and over 60 healthcare service providers.

In 2020, the company created healthcare transparency platform, seeQer, in tandem with the No Surprises Act. The technology provides a comprehensive view of a patient’s benefits, coverage, plan type, and administrative requirements for care, including prior authorization, all in real-time.

To measure the success and accuracy of the platform, careviso worked closely with current clients in this multi-part series.

Defining What Success Means for seeQer

According to a survey from Medscape, physicians spend 15.5 hours per week on administrative work. In that 15.5 hours a week, laboratory staff spends time calling health plans and insurers. The information received from phone calls often varies in completeness and consistency.

In a separate study, careviso concluded that the physician office phone call to the health plan matched the claim from the health plan 59% of the time.

To test seeQer’s success and accuracy, careviso received patient data sets from current clients. seeQer technology solution was performed to estimate patient cost responsibility. The seeQer results were then later compared to the claim from the health plan.

For this series, the seeQer result was compared to the claim, because the claim is a direct reflection of what the patient was billed, whereas the phone call is more variable.

careviso Client: National Genetic Testing Lab & Prominent Children’s Hospital

Featuring data from Q4 2024

The Study

careviso collaborated with a large genetic testing laboratory client who supplies tests to a prominent children’s hospital.

The cases evaluated were highly complex and often involved multiple insurances and codes, adding to the administrative burden placed on laboratory and hospital staff. The goal was for seeQer to produce an accurate result when compared to the claim, so that staff members could instead focus on providing high-quality care and support for patients.

The Results

seeQer proved to be highly accurate and effective, pulling a reasonable or exact result for 76% of cases.*

For the remaining 24% of cases, seeQer either overestimated (17%), or underestimated (7%) what the patient had to pay. When the platform was not accurate, it reverted to overestimating the patient responsibility, which typically involves a deductible already being met. When analyzing underestimation, health plan coverage was a primary factor.

• In 76% of cases, seeQer pulled a reasonable or exact result.*
• In 17% of cases, seeQer overestimated what the patient had to pay.
• In 7% of cases, seeQer underestimated what the patient had to pay.

* Within the margin specified in the No Surprises Act

seeQer Saves Time Without Sacrificing Accuracy

Due to the high accuracy rate of seeQer compared to claim, laboratory staff can spend less time making phone calls.

careviso’s healthcare transparency platform is a reliable and accurate tool for predicting patient costs and streamlining tasks. By providing real-time information, it helps reduce administrative paperwork and the need for time-consuming phone calls to health plans.

With an 76% accuracy rate for the laboratory client when compared to health plan claims, the platform allows staff to focus on other tasks, rather than tracking down hard-to-find information.

The success of the platform highlights the potential for technology to simplify healthcare processes and improve efficiency for everyone involved. As healthcare continues to evolve, solutions like seeQer can play an important role in addressing burdensome challenges and making healthcare more accessible.

Stay tuned for the final installment of this 3 part series where we compare seeQer results to real claims data. Read Part 1 here.