Data Sheet: HealthEdge Source™ Medicaid - Missouri
A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
With CMS estimating $132 billion in annual improper payments—over 60% of which stem from Medicaid programs—managing accurate and compliant pricing data is a critical imperative for health plans. This document outlines how HealthEdge Source provides a prospective payment integrity solution specifically designed to navigate the complexities of Missouri Medicaid.
By leveraging 10+ years of experience providing Medicaid support to Missouri clients, Source enables health plans to pay claims accurately, quickly, and comprehensively.
Specialized Missouri Medicaid Expertise
Source removes the burden of internal IT efforts through a managed service model that ensures compliance with the Missouri Department of Social Services (DSS) Family Support Division (FSD). The solution offers a hands-off, automatic delivery of Medicaid policy every two weeks, built and maintained by Source Subject Matter Experts (SMEs).
Key operational capabilities include:
- Deep Content Delivery: Access to state-specific fee schedules and payment policies across a wide range of facility and professional provider types.
- Cloud-Supported Infrastructure: A single API design engineered to improve time-to-value.
- Comprehensive Customization: A single source for fee schedules with customization capabilities to meet complex payment arrangements.
- Audit Transparency: Improved transparency for audit and provider relations.
Precision in Pricing and Policy Logic
Source distinguishes itself by managing complex pricing formulas that go beyond standard blanket pricing. The document highlights the specific complexity of anesthesia billing in Missouri, where increments of less than 15 minutes require specific percentage calculations of the conversion factor. Source accurately prices these claims immediately, automatically applying adjustments for services without manual intervention.
The platform covers a comprehensive range of facilities and services, including:
- Ambulance and Ambulatory Surgery Centers (ASC)
- Home Health and Hospice
- Inpatient and Outpatient Services
- Nursing Facilities (NF) and Professional Services
Data-Driven Results and ROI
Implementing Source for Missouri Medicaid payment integrity delivers measurable operational improvements and cost savings. By streamlining workflow and enhancing accuracy, health plans can achieve:
- $5 in savings per identified claim from improved accuracy.
- 40% reduction in claims needing to be re-keyed due to improved workflow.
- 5-8% of total claims identified with inaccuracies.
- 25% time savings over previous processes.
