Hospitals

Cut HMO claim leakage by 38% and shortened the revenue cycle from 74 to 31 days

Multi-specialty Tertiary Hospital

Duration: 6 months to steady state
Team: Partner, RCM lead, 2 analysts, coding trainer
Scope: 220 beds, 14 HMOs, 9 clinical departments
Region: Nigeria

Denial rate

6%

-15pts

Days in AR

31

-58%

Cash on hand

+₦640m

+41%

Claim accuracy

98.4%

+19pts

The full story

Client challenge

A 220-bed hospital was writing off millions in denied HMO claims. Coding was inconsistent across departments and finance had no line of sight into claim status until denials arrived.

The starting position

Claims were submitted in batches, denials arrived weeks later and nobody owned the gap in between. Coding practice varied by department, pre-authorisation was informal, and finance learned about lost revenue only when the write-off hit the ledger.

What we actually changed

We mapped the revenue cycle end-to-end from admission to remittance, then inserted two hard checkpoints — pre-authorisation and coding QA — before submission. Claim status became visible in real time through a BI layer sitting on the HIS, and service-line costing gave the CFO the first honest view of which specialties funded the hospital and which consumed it.

Why it stuck

The weekly denials war-room, chaired by the medical director rather than finance, made clinical leaders owners of the outcome. Denials stopped being an accounting problem and became a quality metric.

Our solution

Deployed a revenue-cycle management workflow with pre-authorisation, coding QA and claims analytics. Rebuilt costing by service line and armed the CFO with weekly leakage dashboards.

Business outcome

Denied-claim rate fell from 21% to 6%. Cash position improved by ₦640m within two quarters and the hospital funded a new imaging suite from internal cash flow.

Implementation process

1
Mapped the end-to-end revenue cycle from admission to remittance across 14 HMOs.
2
Introduced pre-auth and coding checkpoints; retrained 42 clinicians and coders.
3
Automated claim submissions and aging via the HIS + BI layer.
4
Instituted a weekly denials war-room chaired by the medical director.

Expanded engagement metrics

Clinicians retrained

42

coding and documentation

HMOs renegotiated

6

tariff and turnaround terms

Claims automated

94%

submission and status tracking

Service lines costed

9

true contribution per specialty

Write-offs avoided

₦74m/mo

run-rate at month six

Imaging suite funded

100%

from internally generated cash

Denied claims

21% → 6%

Cash released

₦640m

Revenue cycle

74 → 31 days

Before and after comparison
Metric	Before Soteria	After Soteria
HMO denial rate	21%	6%
Days in AR	74 days	31 days
Coding accuracy	79%	98.4%
Monthly write-offs	₦92m	₦18m

"The Soteria team speaks both clinical and financial. That combination transformed our payer relationships."

D

Dr. E. Bassey

Chief Medical Director

Your outcome, engineered

We can run this playbook for your hospitals organisation.

In a 45-minute confidential briefing, the partner who led this engagement will benchmark your current numbers, identify the three fastest sources of value and give you a written scope with fixed fees — at no cost.

Partner-led, not junior-staffed
Fixed-fee scope before we start
First results inside 90 days
NDA signed before any data moves

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