3 Ways a Data Reference Module Can Help Improve Payment Integrity
Medical claims go through a long process of pricing, editing, analytics, and payment. And it’s vital that health plans pay claims accurately, quickly, and comprehensively—the first time.
An integrated workflow management system like HealthEdge Source™ can centralize claims processing and facilitate payment accuracy by offering:
- Contract visibility
- Pricing tools and algorithms
- Analytics and benchmarking
- Custom and history-based editing
- Comprehensive audit trail
- Data modeling
The Data Reference module within HealthEdge Source brings editing and pricing capabilities together in one cloud-hosted platform. Payers get full-audit support and access to actionable insights that help improve payment integrity. Below are three ways a Data Reference tool can give your health plan a claims processing advantage.
Utilize clean, aggregated data from multiple sources
Keeping track of multiple payment schedules and maintaining their accuracy can be a challenge. The Data Reference feature within HealthEdge Source brings together the most up-to-date fee schedule information and is refreshed every two weeks—giving users one less manual task to remember and ensuring higher levels of accuracy. In 2023, the HealthEdge Source delivered more than 1,500 data updates to its users and made more than 350 updates to policy and pricing met—giving users one less manual task to remember and ensuring higher levels of accuracy. In 2023, the HealthEdge Source delivered more than 1,500 data updates to its users and made more than 350 updates to policy and pricing methodologies across all lines of business.
Data Reference delivers insights based on information such as:
- Medicare rates and prospective payment data
- CMS policies and statistics by provider, region, and system
- CMS provider rates and statistics
- ICD-9, ICD-10, and HCPCS codes
Adjust quickly to CMS updates and policies
Information about updated Centers for Medicare & Medicaid Services (CMS) policies and regulations is available in many formats and in multiple locations. Many of the documents containing key information are difficult to understand, and data is not easy to verify between documents. When it comes to provider rate data, for example, health plans have to cross-reference National Provider Identifier (NPI) and Online Survey Certification and Reporting (OSCAR) numbers to match providers and ensure accurate payments.
CMS is expected to make more than 600 changes throughout 2024. Make sure your health plan is ready to adapt to these changes right away. With the Data Reference tool, Source aggregates and aligns key data in a way that’s easier for payers to view, search, understand, and use.
Streamline fee schedule and contract management
When it comes to off-cycle payment updates, some health plans are forced to knowingly pay claims inaccurately because they don’t have the most updated payment information or internal resources to make timely updates. Prevent these issues from impacting your health plan by working with a payment integrity solution that gives you access to the most recent and accessible information—and see it all in one place.
Source users can update payment policy and pricing methodologies to improve fee schedule management, pricing transparency, and auditing. Instead of juggling multiple websites and documents, the information you need is gathered in a single view that allows users to sort data by region and other filters.
Adjust to policy changes, prevent payment delays, and improve provider relations at your health plan by using a payment integrity solution that gives you access to the most recent and accessible information. With the Data Reference tool, you can readily access essential payment information in an organized and searchable format.
