Video: 3M Pricing & Editing - HealthEdge Source

Executive Summary

3M Pricing and Editing Integration

HealthEdge Source™ (Source)'s seamless integration for both 3M pricing and editing in select states ensures accurate payment for health plans. The integrated system allows for the combined or separate use of 3M pricing and editing, enhancing flexibility in current pricing and editing use cases.

Management and Maintenance

The Source team manages the relationship with 3M and provides the latest 3M pricing and editing updates directly through the Source UI. This team also handles all maintenance of the 3M solution, making it easier for health plans to stay current with state-specific Medicaid grouping and reimbursement requirements.

Pricing Integration

For pricing, the integration utilizes the 3M™ Grouper Plus Content Services (GPCS) cloud-based solution for All Patients Refined Diagnosis Related Group (APR DRG) and Enhanced Ambulatory Patient Group (EAPG) pricing, which is important for acute inpatient and hospital outpatient state Medicaid pricing. This system provides flexible payment rules that can be adjusted as needed.

Editing Integration

For edits, 3M's proprietary APR DRG and EAPG policies support state-specific Medicaid programs. These policies include medically unlikely edits (MUEs), invalid procedure and modifier adjustments, billing guidelines, and more. Source's library of 3M policies can be customized to meet health plan needs, including enabling or disabling policies, monitoring them, adjusting their dispositions, or creating exceptions.

Benefits of Integration

With Source's integration of 3M pricing and editing, healthcare organizations can achieve enhanced accuracy, flexibility, and efficiency in their operations, ensuring compliance with state-specific Medicaid requirements.