Infographic: Future-Proof Claims Editing for Real Savings with Source Editing
EditingHealthEdge® listed as a Representative Vendor in the 2023 Gartner® How U.S. Healthcare Payer CIOs Can Future-Proof Claims Editing report.
HealthEdge Source™ has successfully collaborated with healthcare payers to identify significant opportunities for delivering payment integrity savings. By integrating Source Secondary Editing with existing editing solutions, Source has achieved notable results:
- Increased Savings: Identified and captured incremental savings across multiple payer types.
- Reduced Contingency Spend: Minimized the costs associated with contingency arrangements.
- Improved Transparency: Enhanced visibility into payment results, promoting greater accountability.
- Eliminated Improper Payments: Addressed and prevented recurring improper payments.
Key Data Studies and Payment Integrity Savings
- Mid-sized Regional Health Plan (Medicare Advantage):
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- Claims Analyzed: 1.7 million claims
- Total Spend: $648 million
- Incremental Savings: 1.6%, or $11.1 million
- Regional Health Plan (Medicaid):
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- Claims Analyzed: 2.1 million claims
- Total Spend: $571 million
- Incremental Savings: 1.6%, or $9.1 million
- National Health Plan (All Lines of Business):
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- Claims Analyzed: 5.1 million claims from Medicaid and Dual Eligible members
- Total Spend: $790 million
- Incremental Savings: 1.1%, or $8.7 million
These results were achieved by analyzing claims both pre-pay and post-adjudication, ensuring that savings could be realized without altering the current editing stack. The use of a unique, pre-built Payer-Source integration for secondary editing in the adjudication process proved crucial.
Unlock the Potential of Accurate and Efficient Claims Processing
Source's prospective payment integrity platform within HealthEdge enables accurate, rapid, and comprehensive claim processing from the outset. This innovative approach not only promises substantial payment integrity savings but also sets a new standard in claims adjudication.
To learn more about how Source can transform your payment processes and deliver significant savings, visit HealthEdge Source.
