Administrative expenses have risen sharply, with hospitals recording that more than 40% of care delivery costs are now devoted to meeting commercial insurer requirements. Novus360 can help reduce the time staff spend on prior authorizations, appeals, audits, and complex onboarding workflows—diverting resources from patient care.

The frequency of commercial claim denials has grown—20.2% increase from 2022 to 2023—forcing providers to dedicate additional resources to appeals and resubmissions. Many denials result from automated or algorithm-driven processes performed without clinical review, creating uncertainty about coverage and requiring extensive follow-up before payment is secured. Novus360 utilizes advanced logic to ensure claims are processed appropriately the first time. Our Utilization Management team performs the appropriate review of claims to ensure the correct decision on medical necessity of care.

Many payors depend on legacy systems with manual touchpoints, siloed data, and limited interoperability, contributing to inefficient workflows, redundant processes, and errors. Novus360’s fully integrated solutions solve the issues due to the lack of seamless integration between claims, eligibility, and provider management platforms, causing persistent delays and rework

Commercial payors must track numerous, often state-specific regulations on claims processing, timely payment, policyholder disclosures, and fraud prevention. Failure to adhere to rapidly changing legal mandates can expose payors to market conduct fines, enforcement actions, and reputational risks. Novus360 is designed to help Payors adhere to these regulatory requirements and help protect against fraud.