Video: Monitor Mode - HealthEdge Source

Monitor Mode Payment Integrity in Source

HealthEdge Source™ Monitor Mode allows health plans to review the impacts of edits before applying them to production. By doing so, it helps in understanding the potential effects on claims processing without disrupting the actual workflow, thereby ensuring a smoother transition and more informed decision-making when implementing new edits.

How it Works

1. Setting Edits to Monitor Mode: Any edit in the application can be flagged for monitoring. This means that while these edits are not applied in the production workflow, they are still analyzed for their potential impact.

2. Dual-Run Process:

First Run: Claims are initially priced and edited using the current production configurations.
Second Run: The same claims are then run a second time with all the edits set to Monitor Mode. This allows for the collection of data on how these edits would affect the claims without actually implementing them in production.

3. Data Population: The results from the second run populate a comprehensive dashboard. This dashboard includes various aggregators that allow users to view the data by claim header, claim line, configuration, or ancillary fields.

4. Assessing Impact: Users can assess the impact of individual edits by using the edit ID. For more complex queries, the dashboard can adjust the view of the data based on specific criteria, such as provider NPI. This enables health plans to see down-to-the-penny impacts on each individual provider.

Check out our resources to learn how Monitor Mode can transform your payment integrity process.