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Taming the Mess of Medicaid Payments Through Technology

Bad data is estimated to cost the healthcare industry $314 billion annually and negatively impact an organization’s revenue by 10-25%. The claims payment structure is characterized by decentralized data and delayed pricing updates leaving plans scrambling to keep up with CMS and Medicaid policy changes and struggling to price Medicaid claims accurately.

Addressing this outsized demand on insurers and their technology partners requires getting control of your data. With annual stats like an expected Medicaid enrollment growth of 5.8% and a 9.5% claims payment error rate, technology that can make data more meaningful and actionable is the solution. Successful organizations have focused on three technology solutions to achieve consistent, accurate, and transparent payments:

  • SaaS technologies
  • Integrated ecosystems
  • Centralized data
  1. SaaS technologies

Challenge: Your traditional solution for first-pass accurate claims processing relies heavily on manual and infrequent data, and policy updates that are not aligned. Variability in pricing methodologies adds complexities to processing your claims.

Solution: A platform that delivers frequent updates to Medicaid baseline data with software as a service, so you’re always working with up-to-date prices and edits, preventing inaccuracies with real-time data. Because it’s in the cloud, no internal resources are required to deploy the changes. First-pass claims payment accuracy is increased dramatically – enabling your business teams to refocus on value-added activities.

  1. Integrated ecosystems

Challenge: Multiple and different technology platforms across the organization impact the integrity of your data and the information exchange environment.

Solution: A unified platform that brings software, data, and service into a single workflow. Implementing one technology platform that delivers up-to-date regulatory data, claims pricing and editing, and real-time analytics tools gives your organization an edge over the competition. A single source of truth and a single point of accountability is a transformational approach for payers to make payments with total confidence and make business decisions with real intelligence.

  1. Centralized data

Challenge: Your workflows and data are managed across multiple platforms that are not exchanging information in the same language, frequency, or format – wasting time and increasing the risk of errors.

Solution: A unified, cloud-hosted platform enables a single place to centrally update, maintain, and manage data with multiple entities. This automated approach reduces IT maintenance delays and delivers centralized, accurate data.

Source is HealthEdge’s prospective payment integrity solution, a cloud-based platform built to specifically address the burden of these challenges. Join our webinar on May 5 and learn how SummaCare modernized its processing and realized big savings. Register here.