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Month: July 2020

Commonly Asked Questions by Health Plans Seeking New Solutions-Software Exploration

We understand that choosing a new solution can be a daunting task and that making changes can have an extensive impact on a company’s success, employee productivity, and the members served. If you are considering a change, whether it be upgrading your claims systems, taking on more risk, outsourcing parts of your operations, or improving your data management, we can help.

To aid in your process, we have decided to share the top questions we received from health plans looking for solutions to improve operations and grow membership. This post is the first of a three-part series. Over the coming weeks, each blog will cover five commonly asked questions about our healthcare technology, services, and analytics capabilities.

 

To begin the conversation, we start with our technology questions.

What sets your claims system apart from your competitors?
Our cloud-based system built on .NET is the most recent claims system released to the market. The next-generation architecture and tools allow the system to be highly scalable, to support limitless expansion, modifiable, to allow for customization without the need for custom programming, and interoperable, to account for changing demands of health plans to collaboration with new partners. Our robust portal offerings work seamlessly with our core platform, providing a complete end-to-end solution.

Do we need a dedicated IT department to make modifications to the system? No, our system is compatible with all lines of business and supports multi-administrative office models. With initial training, any front-end office administrator can manage our flexible rule-based structure to customize and modify logic, workflow, reports, and interfaces. Also, we offer turnkey EDI integration for eligibility and capitation data for all health plans.

Do you have strong search features for users to interface easily with the claims platform?
Our Claims Module gives the users the power to search for and sort by date of service, claim number, claim type, payment date, and other search criteria. Several web-based portals are used for members and providers to access claim information. The Provider Portal allows for the search of claims submitted by the provider, and our Member Mobile Portal shows the claim information for the member and the current status.

Receiving and paying claims is a vital part of our business, what is the turnaround time?
Claims are received via 837 or paper. If we perform BPO services for a client, paper claims are entered within 48 hours. We pay 95% of claims within 30 days. Through our auto-adjudication process, claims are paid within 24 hours. We also can offer real-time pay. Your team can choose to vary payment timeframes based on your business model.

What type of standard claims administration reporting is included in the technology package?
Our standard claims reports include but are not limited to the following: Claim Aging Report, Claim Audit Summary Report, HCFA with Line Summary Report, Status and Counts Report, Time Service Report, and UB04 Summary by Claim UB04 with Line Summary Details. If you need a more customized report, our team can work with you to help create what you require.

 Stay tuned for questions regarding our services and analytics. Feel free to reach out and schedule time with us to discuss specific questions about your unique situation.

 

Michael Friel, Compliance Officer speaks on healthcare compliance regulations and how to remain apprised of industry changes

This month we are speaking to Michael Friel, Compliance Officer, on the latest healthcare compliance regulations and how he keeps on top of the evolving industry of healthcare compliance.  
Healthcare compliance rules are continuously evolving. How do you stay informed of the latest developments?   

I learn something new every day in the changing regulatory environment. We devote time and effort to policy changes and stay current by following key industry sites like the Center for Medicare & Medicaid Services (CMS). I am grateful to be a part of an exceptional team and network of industry friends. We work together to understand and enact the adjustments. 

How do you communicate or introduce new compliance requirements that need implementation?   

We first discuss new regulations with our employees in the impacted area. Our team addresses each requirement to meet their unique circumstance. By gathering their expert intel, we can be sure to address any potential direct impacts on daily operations and work together to make the necessary changes. We follow up by conferring with industry professionals. Sometimes, we make a small policy or procedure change through communication and training. With more complex changes, like Covid-19, we break down the pieces and ensure compliance and effectiveness by combining our team’s suggestions with research and industry best practices.   

What are some of the latest industry changes that we have adapted to at HealthAxis Group?   

The one on everyone’s mind is Covid-19. Everything changed, from how and where we work to the way our clients service their members. Honestly, whoever would have thought of a parking lot as a medical testing site? The medical regulatory field is constantly evolving and so are we. Our leadership and teams adapted quickly and effectively to step up to the challenge when the pandemic hit. Our agile nature allowed us to be flexible and successful when, unfortunately, some industries and companies were not.  

What is the best resource for medical professionals to find the latest compliance information? 

Find a partner you trust. My dad was a doctor, like other medical professionals, he spent numerous hours staying current on ever-changing trends in medicine. Keeping track of CPT Billing codes and healthcare company requirements is also a full-time job. That’s why partnering with a professional who knows your needs, understands your business, and has innovative solutions is key.