Data Sheet: Source Claims Modeling

HealthEdge Source™ (Source) contract modeling solution empowers health plans to leverage modeling of historical claims data. This tool provides actuaries, analysts, and medical economics teams with the ability to perform ad-hoc "what if" analyses using a recurring .CSV or JSON file transfer process to and from the Source platform.

Key Features of Our Source Claims Modeling Solution include:

• Flexibility to use existing Source production configurations or customize your own.
• Support for any methodologies available in Source, including custom fee schedules and government-based policies.
• Automated updates of all CMS and Medicaid payment policies every two weeks.
• Unlimited configurations and fee schedules to build and access.
• Support for contract terms going back multiple years.
• Immediate reporting with detailed pricing results, enabling users to analyze and export data into MRF or PDF formats.

Self-Service Modeling and Analysis Tools:

• Easy Build Models through Source’s Design Module, which mimics contract terms and includes multiple payment methodologies.
• Flexible Data Selection from stored claims data within Source, allowing users to perform various data studies effortlessly.

Use Cases for Source:

• Assisting with contract renewals and rate assessments.
• Evaluating the impact of regulatory changes.
• Establishing baselines for negotiations.
• Assessing discrepancies between modeled and actual payments.
• Supporting capitation, value-based contract performance, and rate setting.

Added Value:

• Consolidation of analysis tools.
• Removal of manual processes.
• Enhanced accuracy and reduced risk of errors.
• Easy promotion of models to production.

Advanced Reporting:

• Powerful comparison of historical data against multiple models.
• Multi-dimensional reports aggregated by demographics, product line, contract, and provider categories.
• Export capabilities for tailored needs.

Future Benefits:

• Rapid decision-making through integrated modeling analysis tools, reducing what takes weeks or months in other solutions to a single day.
• Consistency across departments with flexible usage and access provisioned by role.
• Increased forecast accuracy due to industry-leading two-week update cycle.
• Efficient contracting by confirming feasibility before negotiations.
• Improved workflow with reduced costs by eliminating the need for multiple third-party vendors.

In summary, our contract modeling solution offers streamlined operations, enhanced decision-making capabilities, and cost-efficient contract management for health plans. By integrating advanced modeling tools within Source, we aim to provide stakeholders with the most accurate and reliable data analysis to drive better business outcomes.