Video: Retroactive Change Manager Introduction - HealthEdge Source
In the dynamic healthcare landscape, retroactive changes are inevitable. Every health plan has faced these changes, whether it's a fee schedule edit, a pricer update, or a provider contract alteration. If not managed proactively, these changes can lead to significant financial discrepancies.
Frequency of Changes:
- For 2023, we anticipate over 600 retroactive changes across health plans.
- These changes can easily result in substantial amounts of money being incorrectly paid out.
HealthEdge Source™ Retroactive Change Manager
Solution Overview
- The Retroactive Change Manager within HealthEdge Source is designed as an automatic and proactive solution.
- The tool provides comprehensive insight and simplifies the management of retroactive changes, ensuring financial accuracy and compliance.
Operational Benefits
- Automated identification of payment changes.
- Quick identification of all claims needing adjustments.
- Avoidance of millions in post-payment recovery fees.
Financial Impact
Many health plans depend on payment integrity vendors that charge high fees and address claims only after payments are made, leading to increased costs. The Retroactive Change Manager reduces these expenses by automatically detecting payment discrepancies through clear and transparent variance reports.
Efficiency and Compliance:
Health plans that use Retroactive Change Manager see significant improvements in compliance. The solution simplifies passing audits and enhances relationships with providers by ensuring accurate payments.
HealthEdge Source Retroactive Change Manager offers a proactive solution to a longstanding challenge in the healthcare industry. By addressing retroactive changes with innovation and efficiency, it empowers organizations to maintain financial stability and streamline operations, ensuring they can focus on quality care.
