Case Study: AmeriHealth Administrators
With market dynamics impacting health plans dramatically, the one-size-fits-all-approach no longer works.
AmeriHealth Administrators (AHA) is recognized for its ability to adapt and innovate in the healthcare industry. Under the leadership of Michael Robak, Vice President of Service Operations, and Michael Sullivan, President and CEO, AHA has strategically positioned itself to meet the evolving demands of the healthcare market. The company embraces agility and flexibility through its LEAP technology platform, powered by HealthEdge's HealthRules Payer® system. This platform enables AHA to roll out new benefits, plans, and services efficiently without the need to rebuild from scratch each time.
Improvements with HealthRules Payer CAPs
AHA's transformation is rooted in modernizing its technology, processes, and people, allowing it to offer superior capabilities in self-funding and business process outsourcing (BPO) services. The switch to HealthRules Payer has resulted in significant improvements, including a 30% increase in claims auto-adjudication rates and 99.6% financial accuracy in claims processing. The ability to configure systems to match business processes precisely and manage products as reusable components has drastically reduced the cost and effort required to bring new products to market.
Transforming the Healthcare Landscape
The company's focus on flexibility and customer satisfaction has led to the development of advanced analytics capabilities and a client-centric support model that emphasizes education, consultation, and innovation. These efforts have positioned AHA as a leader in providing tailored solutions that meet the diverse needs of its clients.
AHA aims to migrate most of its self-funded business to the HealthRules Payer platform in the near future, continuing its commitment to leveraging cutting-edge technology to enhance efficiency and improve claims processing. The company's ongoing investments in technology and process optimization ensure that it remains at the forefront of the healthcare industry, ready to tackle new challenges and seize emerging opportunities.
Learn more about how AHA is transforming the healthcare landscape with innovative solutions designed to improve claims processing and drive customer satisfaction.
