Hospitals and healthcare providers often face challenges in optimizing their revenue cycle management due to complexities in payer contracts, billing methodologies, and evolving reimbursement models. These inefficiencies can lead to revenue leakage, underpayments, and delayed payments, significantly impacting their financial performance.

Sapphire RCMS provides an AI-powered analytics platform designed to optimize payer net patient revenue (NPR) for healthcare providers. The platform aggregates and analyzes claims, contract, and financial data to identify revenue leakage, improve contract negotiations, and ensure accurate and timely payments. By leveraging proprietary algorithms and processes, Sapphire RCMS helps providers uncover underpayments, reactivate lost revenue, and prevent future revenue leakage through continuous contract compliance audits. The solution aims to place providers on an even playing field with payers, ensuring they are paid correctly and on time.

AI-driven analytics to identify underpayments and revenue leakage

Contract negotiation tools to improve payer agreements

Continuous contract compliance audits to prevent future revenue loss

Claims data analysis to uncover and reactivate lost revenue

Proprietary algorithms and processes to optimize payer NPR

Integration with existing healthcare systems for seamless data aggregation

Blockchain technology to enhance data security and transparency

The primary target audience includes hospitals, healthcare systems, and accounts receivable management firms seeking to optimize their revenue cycle management and improve financial performance.

Sapphire RCMS solutions can impact contract performance and net patient revenue by up to 10% and reduce operating expenses by at least 50%. The company has recaptured $50M in managed care and fee schedule based NPR from one hospital system.