Improve Payment Calculations and Transparency with HealthRules® Payer Machine Readable Files
Healthcare is experiencing a significant digital transformation, and the HealthRules® Payer Machine Readable Files (MRF) Suite is at the forefront of this revolution. This innovative software suite, developed for HealthRules® Payer, is an industry game-changer, offering a superior solution to manage and publish Machine Readable Files (MRF) of negotiated rates and allowed amounts.
What is the HealthRules® Payer Machine Readable Files Suite?
The HealthRules Payer Machine Readable Files (MRF) Suite is a cloud-based SaaS application specifically designed to help health plans streamline the process of calculating and publishing rates.
With the Machine Readable Files suite, health plans can create accurate, comprehensive MRF files swiftly and efficiently via a user-friendly web interface. Users can also manage, track, and establish operational processes to publish multiple MRF files as needed to maintain compliance. This cutting-edge solution is an essential tool for complying with the mandate from the Centers for Medicare & Medicaid Services (CMS) for Transparency in Coverage and MRF Requirements.
Benefits of using the HealthRules® Payer Machine Readable Files Suite
What do health plans get with the HealthRules Payer Machine Readable Files Suite? Using this innovative offering, our customers gain access to benefits such as:
Industry-Leading Accuracy: The MRF Suite calculates negotiated rates based on Supplier Contract Agreements and historical billing code combinations through a partial adjudication process to help ensure highly accurate results.
Faster Execution Time: Intelligent rate processing features significantly reduce redundant processing and increase billing code coverage.
Flexible and Intuitive Configuration: The solution features an easy-to-navigate, web-based user interface that makes it easier to configure, manage, and track MRF generation.
CMS-Compliant Files: With the MRF Suite, users can produce files compliant with the CMS schema for negotiated rates, allowed rates table of content files
Key Features of the HealthRules® Payer Machine Readable Files Suite
How are our customers achieving these critical business goals? By leveraging MRF Suite features such as:
Intelligent Rate Processing
With the MRF Suite, users can calculate negotiated rates for up to 4.8 million provider billing code combinations daily. The solution also uses historical negotiated rates and shorter runs to refresh changing rates as configured. Plus, users can reuse and map existing negotiated rates.
Flexible Web-based UI
The MRF suite offers an intuitive user interface (UI) that facilitates file configuration, management, and tracking—including asynchronous initiation and monitoring. Users can access flexible configuration options to generate different MRF files according to their unique needs. Health plans can also use the solution to monitor the status of MRF processing runs with a live throughput and count of the claims’ combinations. And, as an added bonus, users can download intermediate files generated in the MRF pricing process.
Data Optimization and Processing
MRF suite users can reduce processing and execution time by storing and reusing generated data. Automated data cleanup and re-evaluation helps to ensure data accuracy and storage optimization, and scheduled incremental runs more easily update negotiated rates. Health plans can adhere to compliance rules and make sure their files are published on time.
Next-Generation Performance
Avoid rate reprocessing rates in case of MRF run failures. Incremental rate updates in the MRF suite generate more comprehensive billing code sets. The web-based UI simplifies and automates monthly operational tasks and monitoring for faster completion—and a 70% time reduction with incremental runs.
Enhance Performance with Machine Readable Files
The latest version of the MRF Suite enhances value for health plans with a 25% reduction in execution time and a 40% improvement in performance—while helping maintain accuracy and storage optimization. It also facilitates more timely publishing of on-demand MRF to improve compliance and reduce operational costs.
Health plans utilizing the MRF Suite have witnessed substantive improvements in performance and compliance. With the updated MRF suite, users see a 40% average increase in daily provider billing code rates throughput and a 28% faster execution time. And the inclusion of incremental runs leads to a 70% reduction in execution time and a larger coverage of billing codes.
HealthEdge is on a mission to drive digital transformation in healthcare, connecting health plans, providers, and members with cutting-edge technology solutions. Our end-to-end digital technology solutions support rapid member growth, new business models, and improved health outcomes.
If you’re looking to transform your health plans’ MRF publishing processes, the HealthRules® Payer Machine Readable Files could be the solution you’ve been waiting for. To find out more or to schedule a demo, watch our videos:
