How Health Plans Can Use Advanced Analytics to Address Common Challenges
Health plan administrators must adhere to the complex guidelines related to payment integrity, operational efficiency, and regulatory compliance. The claims process is intricate, and the sheer volume of requests and disputes can be overwhelming.
Adopting the right technology platform can reduce the need for manual intervention and rework—turning a long and error-prone process into an accurate and automated task. Solutions that include advanced analytics capabilities can help health plans leverage their data more effectively to streamline operations and enhance decision-making.
Below are a few recommendations on how health plans can use advanced analytics to further their organizational strategies.
3 Benefits of Leveraging a Solution with Advanced Analytics
Advanced analytics give health plans the customized insights they need to make more informed decisions. The right solution should allow users to see claims totals before and after editing, and understand how an edit will impact a provider before it’s enabled.
1. Configurability and Flexibility
Modern analytics tools offer greater configurability and flexibility than legacy systems that rely on manual data review. Advanced analytics allow users to leverage accurate and up-to-date insights. Reporting customization helps health plan leaders make more informed decisions while maintaining compliance with evolving policies and regulations. By reducing the risk of penalties, health plans can focus on delivering quality care.
2. Integration and Automation
Integration capabilities are vital to maintaining a functional and agile technology ecosystem. An ideal analytics tool should seamlessly integrate with claims systems across commercial and government lines of business, simplifying portfolio management. Automated data review accelerates the claims payment process while minimizing errors, giving teams more time to focus on strategic initiatives.
3. Greater Transparency and Control
Transparency builds trust. An advanced analytics tool can give health plans greater visibility into edits and configurations performance, enabling them to demonstrate efficacy and establish more trusting relationships with providers and other stakeholders. Managing payment integrity internally also helps reduce reliance on external vendors and point solutions—lowering costs and giving them greater operational control.
Address Common Health Plan Challenges with HealthEdge Source
HealthEdge Source (Source) is designed to transform health plan claims processes with an innovative pre-pay model, designed to handle common industry challenges beyond payment integrity.
Combat Rising Healthcare Costs
Rising healthcare costs straining health plan resources. Source provides detailed insights into payment integrity performance through the Advanced Analytics module. By analyzing data on overpayments, underpayments, and potential fraud, health plans can quickly and easily identify areas for cost reduction and optimization.
Ensure Regulatory Compliance
Navigating the complex web of regulations can be daunting. Advanced Analytics empowers health plans to monitor the release of new rules and remain agile to changing regulations. Real-time data and reporting enable swift adjustments to new requirements, minimizing the risk of costly penalties.
Enhance Data-Driven Decision Making
Comprehensive and real-time reporting from Source enables health plans to make better-informed decisions quickly. Accelerating key business decisions can allow health plans to stay flexible in their offerings and operations.
Key Capabilities of the Advanced Analytics Module from HealthEdge Source
HealthEdge Source offers a robust payment integrity solution featuring advanced analytics capabilities. The Financial Impacts and Monitor Mode are two key analytics and modeling tools that can revolutionize the health plan claims processes.
Financial Impacts
The Financial Impacts dashboard provides invaluable insights into a health plan’s unique production use cases. By collecting data on all enabled edits—including Medicare, Medicaid, third-party, and custom edits—the tool can deliver detailed statistical and financial data. This dashboard also flags any edits causing significant financial impacts, making it easier for health plans to quickly determine whether the change is beneficial. Access to these insights helps streamline claims operations and reduce adjustment rates for more increased operational efficiency.
Monitor Mode Module
The Monitor Mode dashboard allows health plans to test edits against production data and review potential impacts before enabling them. This feature is beneficial when building new custom edits, as well as testing edits to meet requirements from the Centers for Medicare and Medicaid Services (CMS). The Monitor Mode module runs claims twice to better assess the impact of monitored edits, to help avoid unnecessary disruptions after the edits are made. Doing so helps streamline workflows, reduce costs, and improve payment integrity.
The Advanced Analytics tool from HealthEdge Source drastically reduces the need for manual claim reviews and offers automated data collection and analysis. With the solution’s testing capabilities, health plans can feel confident in the adjustments they make to their claims processes.
Advanced analytics have immense potential to address the multifaceted challenges faced by health plans. From combating rising costs to ensuring regulatory compliance and data-driven decision-making, analytics tools like HealthEdge Source offer invaluable support.
Watch our overview video on the Analytics tool to see how your health plan can optimize payment accuracy and efficiency.
