Payer ROI Calculator. That's SMART!

• Marketing materials, including a policy benefits booklet
• Explanation of Benefits statements
• Claim-related correspondence, including denial letters
• Member services/call center call volume via appeal avoidance

To produce this calculation, we leveraged data from reputable sources such as CMS, HHS, Kaiser Family Foundation, industry averages, and insights from our valued customers. Our calculations involved estimating gross plan revenue based on the number of enrollees you provide. We then projected the number of denied and appealed claims linked to communication clarity issues and determined the estimated count of successful appeals.

Additionally, we factored in costs associated with denial letters containing incomplete or inaccurate information, which contributed to successful appeals. We also considered the expenses related to handling and reprocessing communication-caused appeals. Lastly, we projected savings that would be realized by a reduction in call volumes connected to these appeals.

Certainly! You have the flexibility to customize the assumptions for your ROI calculations, and we encourage it. To receive a detailed ROI analysis tailored to your unique needs, please select one of the two buttons above.

This ROI calculator is designed to be an informational and educational tool only and do not constitute advice. We recommend that you obtain independent advice in respect of such ROI. This model is provided as a rough approximation of future financial performance based on the information you provide. The results presented by this calculator are hypothetical and may not reflect the actual ROI. SmartComms SC Limited and its affiliates are not responsible for the content, results, or accuracy of the information on the calculators. SmartComms SC Limited and its affiliates are not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information provided by these tools. SmartComms SC Limited and its affiliates are not responsible for any human or mechanical errors or omissions. The results of the calculations are not a promise or guarantee of a customer’s eligibility or terms for a specific product or service.