Case Study: Large Southeast Payer
In partnership with Source, a HealthEdge company, a Large Southeast Health Plan has revolutionized its claims management process through the implementation of Source’s Payment Accountability platform.
Accurate One Pass Pricing and Editing Solution Leads to Cost and Time Savings
In partnership with Source, a HealthEdge company, a Large Southeast Health Plan has revolutionized its claims management process through the implementation of Source’s Payment Accountability platform. This cloud-based solution was designed to streamline claims pricing and editing using the latest regulatory data, addressing the inefficiencies caused by legacy systems.
Challenge
The health plan faced significant challenges in claims processing, with 30-40% of incoming claims marked for pricing inquiries or manual intervention. This often involved rekeying claims with over 100 lines, consuming valuable time and resources.
Solution
The Director of Policy & Editing sought a solution to eliminate redundant tasks and save time. Source’s Payment Accountability platform offered a one-stop solution for accurate one-pass pricing and editing. The platform's flexible design and current data integration made it a robust tool for managing claims efficiently.
Results
By implementing Source, the health plan achieved:
- First pass accurate pricing
- Annual savings in the six-figure range
- Reduction of 40% of claims needing rekeying
- Elimination of manual pricing processes
- 25% time savings over previous processes
Source’s proactive approach also allowed the payer to address specific issues, such as emergency pricing legislation reform and three-way pricing administration, thereby improving overall claims management efficiency.
