How to Streamline Claims Operations with FAIR Health Integration into HealthEdge Source

Healthcare payer claims operations teams often face additional work and processing when working with multiple claims or data systems. Scattered processes and data lead to waste, inaccuracies, and friction within a health plan’s IT ecosystem that translates to the payer-provider relationship. 

Gain a Competitive Edge by Consolidating Your In-Network and Out-of-Network Pricing Management

Specifically designed to extend to third-party best-of-breed content solutions, HealthEdge Source™ uniquely addresses these challenges. With this integration, payers can seamlessly incorporate FAIR Health data into their workflow to streamline in-network and out-of-network pricing for Medicare parts A and B, or any line of business that utilizes FAIR Health. 

FAIR Health is a renowned third-party vendor that collects data for pricing management. It uses pricing benchmarks based on the region and zip code, as well as national averages, providing just the kind of data needed to streamline your operations and cut out wasteful processes.  

The Value of Integrating FAIR Health’s Data with HealthEdge Source

Utilizing FAIR Health’s robust data offerings and bringing them to Source is a significant step in providing our clients with more value. It enables Source members to deliver unique insights and analytics that could transform your claims operations – making them more efficient and cost-effective. 

The FAIR Health integration will not only resolve common issues you face but also potentially introduce UI changes based on client requests. This can include data reference views and new pricers connected to the FAIR Health fee schedule. The latter is similar to wrapper pricers and other third-party pricers presently in Source.  

Moreover, users can expect potential enhancements in configurations, unlocking even greater capacity for your operations. Our development teams are working behind the scenes on utilizing a data pipeline for file transformation to ensure this integration provides maximum advantages for your health plan operations. 

The End Goal: Smoother Workflow and Seamless Integration

Ultimately, the end goal is to facilitate a smoother workflow and a more seamless integration between multiple claims or data systems. The integration of FAIR Health content into HealthEdge Source opens up a myriad of opportunities for healthcare payer claims operations teams to streamline their processes and work more efficiently.