eric, Author at HealthAxis

This month we speak to Peggy Dell’Orfano, Executive Assistant to the Chief Healthcare Operations Officer, about the importance of her position, teamwork, and her experience working for HealthAxis during a pandemic.

How are your role and teamwork important?

I think of my role as a bridge and a gatekeeper, supporting our Chief Healthcare Operations Officer on a day-to-day basis by helping her stay aligned and focused on her tasks and role. Without everyone working together, the company doesn’t grow collectively. I’ve found that getting the right relationship brewing with my boss and coworkers as an executive assistant is critical for the smooth operation in any company pushing to drive an industry forward.

Why do you think HealthAxis is a great place to work?

The diversity, the culture, the amazing people here, and knowing the leaders are working together with the employees towards growth, success, and better opportunities, not just for the company but for their employees.

What has been the most rewarding experience in your time with HealthAxis?

In my position, I’ve not only worked for C-Suite executives but with the whole company. I’ve always tried to maintain a positive attitude and have a smile for everyone I meet. Since we’ve started working remotely and being with the company only a couple of months, I’ve had people reach out to me on Teams and say ‘hi,’ or ‘I miss seeing you.’ It has let me know that this is where I belong, and that I’m a part of the company, and just how great my co-workers are.

How has your experience been since the Covid-19 remote work transition?

I have continued to learn and develop my skills through the process. I started right before the pandemic so, I’ve had to learn fast in the virtual space, but my supervisor and everyone has been great in helping and guiding me through each process. Although I do love the convenience of working remotely, I do miss the interaction, seeing faces, smiles, and being able to spend more time with my co-workers.

HxOps is the full package of our complete third-party administration services. Offering extensive, flexible front and back-office administration with a customer-first methodology that boosts productivity, improve processes, and reduce costs.

What makes HxOps stand out from other systems?

Our systems are continuously enriched to meet and exceed best practices. We are a trusted tech-enabled partner to outsource your non-core functions. HxOps allows your operation to pay health insurance claims faster, more accurately, and at a lower cost. We maximize your potential by optimizing the relationships between utilization, cost, and outcomes. Our solutions are designed to enable clients to better align payers, providers, and patients through improved communication. With HxOps you can increase access to data and improve the speed and accuracy of data exchange while growing membership and improving star ratings.

What are the key solutions?

Appeals & Grievances
Claims Administration
Compliance Consulting
Credentialing
Enrollment
Fulfillment
Medical Management (UM/CM/DM)
Member Services & Communications

MRA
Over the Counter
Premium Billing
Provider Maintenance
Provider Services & Communication
Revenue/Risk Management
System Configuration

Who does HxOps benefit?

All Medicare, Medicaid, commercial, self-funded, dental and vision plans, Individual Practice Associations (IPAs), and Accountable Care Organizations (ACOs).

What can HxOps do for you?

HealthAxis offers a customized approach to third-party administration services, outsource all plan operations, a targeted line, or a single line of service. HxOps provides quality service to extend your team with a seamless transition. Leverage our operational scale and technical infostructure for a cost-effective solution.

Where can you learn more?

Contact us today to talk to an industry expert or request a demo to learn more about HxOps and how our services can fully integrate with claims processing technology, HxPro, and data warehouse and analytics solution, HxLogic.

HxPro is a benefit and claims administration system built entirely on next-generation technology, designed for flexibility and performance with highly automated workflows that drive efficiency gains, reduce errors, and ensures compliance.

What makes HxPro stand out from other systems?

HxPro is scalable, interoperable, and modifiable. The cloud-based architecture supports limitless expansion opportunities with service-oriented design and open application programming interfaces (APIs) allow for easy data access and third–party collaboration. The HealthAxis system partners with your team to create unique strategies with the ability to tailor logic, workflows, and interfaces.

What are the key features?

Highly Efficient and Configurable Benefit Design Options
Flexible Contracting Arrangements and Reimbursement Methodologies
Powerful Online, Real-Time Claims Workflow Engine
Integrated Data Analytics and Departmental Dashboards
Extensive Provider Database Management Administration
Medical Management (UM/DM/CM)
Appeals and Grievance Management
Automated Customer Service Call Center Functionality
High Claim Auto-Adjudication Rates
Advanced Medical and Operational Reporting Capabilities
Extensive Data Aggregation and Sharing Capabilities with Trading Partners, Providers, and Members

Who does HxPro benefit?

All Medicare, Medicaid, commercial, self-funded, dental and vision plans, Individual Practice Associations (IPAs), and Accountable Care Organizations (ACOs).

What can HxPro do for you?

If you are looking for a more customized approach to your claims processing, HealthAxis can help. Let our team know how we can personalize our design to best support your growing claims and benefit processing needs. We are always looking to improve our systems to best fit the market’s needs. Send us a note at info@healthaxis.com.

Where can you learn more?

Contact us today to talk to an industry expert or request a demo for your team to view the cutting-edge design, see the power of integrated real-time workflows, and learn how this online engine can help elevate your company’s success.

What good is collecting endless buckets of data if you can’t trust it?

Many organizations are finding themselves in that exact situation. Overcome the skepticism and distrust by developing a robust data quality process. Data quality must be at the forefront of any data warehouse and analytics project to guarantee validity and value within the information you receive.

The key is to focus on 3 main areas of the data quality process to build a solid data quality best practice standard.

The 3 main areas of a successful data quality strategy include:

Data Terminology
Data Profiling
Data Governance

In this blog, we will reveal how to build a sound data governance foundation.

The Building Blocks of Data Governance

At a minimum, Data Governance involves: Data Stakeholders, Data Stewards and a Data Governance Office (or its equivalent).

Data Stakeholders are cross-organizational individuals who create data, use data, and those who set rules and requirements for data. These individuals represent key business subject areas. The data stakeholders should be the functional drivers of your data governance plan. They are the individuals in the trenches using the data on a daily basis and are intimately familiar with issues, concerns and needs.

The next building block in the data governance plan is the data stewards. Data Stewardship is the set of activities that ensure data-related work is performed according to policies and practices as established by governance. Stewards may set policy and specify standards and provide recommendations that are acted upon by higher-level governance boards. Especially for large organizations, a single level of stewards is inadequate. A hierarchy of stewards may be necessary.

These roles typically report to a business function or Data Quality team, with dotted-line accountabilities to Data Governance. These stewards examine sets of data against criteria for completeness and may have other, specific data-related responsibilities.

Establishing the Data Governance Office (DGO) is the third step in the plan. It collects metrics and success measures and reports on them to data stakeholders. It also provides ongoing communication access to information, record-keeping and education, and support to key stakeholders.

Finally, consider implementing a Data Governance Board made up of executive-level stakeholders. Executive business stakeholders are key, influential applications and/or business process owners.

With these key roles involved, accurate and feasible data governance guidelines can be created and even more importantly followed.

Industry Application: Data Governance Enhances HIPAA Protections

Data Governance can be seen in action and is especially important within the healthcare industry. With local, state, and federal laws establishing penalties and fines for breaches in personal health information (PHI), data governance serves to clearly define what is PHI and sets policies that safeguard health data and protect against unauthorized access to patients’ private health information.

HealthAxis Group is exhibiting at the SIIA Virtual 40th Annual National Conference & EXPO

Date: October 12, 2020 – October 15, 2020, 8am-5pm daily

HealthAxis will be showcasing our newest advanced all-in HxOne Solution that includes claims administration, third-party services, and data analytics for Self-insured organizations. We are looking forward to all the great education sessions, virtually chatting and setting appointments with those wanting to make a difference in their operations. Visit us at our booth to learn more.

Organizations collectively provide clinical resources and business process solutions to improve care quality while lowering costs.

Tampa, Florida – August 30, 2020 – Two Tampa-based companies, HealthAxis Group, LLC (HealthAxis), and Toney HealthCare Consulting (THCC), are collaborating to meet the unique needs of government-sponsored and commercial health insurance companies and their members. As experts in their respective areas of healthcare, the organizations draw upon each other to bring creative solutions to health plans to help them drive efficiencies, lower costs and improve health outcomes.

The arrangement brings together THCC’s advisory and medical management-focused service solutions with HealthAxis’ full-service third-party administration (TPA) services and claims and benefits management technology. THCC will provide leadership and guidance on clinical strategy and best practices in clinical operations, quality improvement, accreditation and regulatory compliance to joint customers. In addition, THCC deploys to health plans seasoned doctors, nurses, clinical social workers and therapists to manage and execute essential health management functions on an interim basis or for longer periods of time. These clinicians help individuals with care authorizations, coordination of care across various healthcare providers, and assistance in navigating the healthcare system.

THCC’s specialized services will complement HealthAxis’ business process and administrative services, the HxOps component of their end-to-end, fully integrated healthcare operations solution, HxOne. HxOps includes benefits enrollment, member management, billing, provider credentialing and claims processing. HealthAxis provides web portals for providers and members along with many other back-office and third-party administration capabilities. In addition, the HxOne solution generates quality and performance metrics, identifies and prevents improper claims, supports compliance and more, powered by the most advanced claims system on the market.

“We are excited to be engaging with Toney HealthCare Consulting to bring even more innovative and robust solutions to our customers, and most importantly, help them best serve their members,” said Jason Patchen, president of HealthAxis. “Together, we can bring our clinical, technical and business process resources to the forefront to drive efficiencies, improve outcomes and lower costs.”

The organizations individually and together serve Medicare Advantage, Medicaid and Commercial populations nationwide.

“We have known of HealthAxis and the good work they do for many years. We are pleased to be collaborating with them in a complementary way to meet the needs of health plan customers,” said Sam Toney, M.D., CEO of Toney HealthCare. “There are times in customer engagements when we recognize opportunities to further support customers’ objectives. Our agreement with HealthAxis enables us to draw on each other to deliver creative solutions.”

This month we speak to Torina Gavin, Claims Specialist, about her team and experience working for HealthAxis Group.

Tell us about your team in the Claims Department.

I love my team; we all work so well together. Each member works very hard and plays an important role in the overall company picture. We value one another’s opinions, support one another, and focus on the important task of providing excellent service to the clients.

How do you spend your day?

I work hard every day to support our customers. My time is filled with processing claims, responding to emails, and other requests. I interact with our IT team and member services for support and guidance. We are currently working from home due to the pandemic; our team supervisor has provided excellent resources to ensure a balanced day and workload.

What do you value most about our company culture?

I appreciate the fairness within the company. What I mean is the workload is distributed evenly, and there are equal opportunities for advancement for everyone within the company in all departments.

HealthAxis releases an advanced all-in-one solution to administer claims, third-party services, and data analytics for Health Plans

Tampa, FL, (September 23, 2020): HealthAxis takes health plan claims administration software and services to the next level with the release of HxOne; an end-to-end, fully integrated healthcare operations solution. HxOne combines advanced claims system technology, flexible front and back-office services, and actionable analytics.

HxOne encompasses:

HxPro, a next-generation, claims administration platform that helps streamline healthcare claims processing and health plan management.

HxOps, a series of business processing services that aid in accelerating productivity and delivering first-rate services and quality care to members.

HxLogic, a powerful data warehouse and analytics solution that drives real-time decisions through pre-built, self-service, and predictive capabilities.

“We have been looking forward to this launch for quite a while,” said Shilen Patel, Chairman and CEO. “Over several years, we have developed and acquired key capabilities to embody our HealthOps™ philosophy, managing care and benefits through the holistic interplay between technology, operations, and analytics. From this philosophy, HxOne was born. This sophisticated solution equips clients for the endlessly shifting terrain of healthcare delivery.”

“This was a major endeavor spanning years of effort and investment. There is no way to short cut building a comprehensive and dynamic next-generation system,” said Jason Patchen, President. “Collaborating with our clients to address claim workflow challenges, medical management dynamics, complex provider data issues, appeals and grievances, and analytics, we built a better wheel. The partnership model of development has led us to re-imagine a scalable, efficient platform capable of supporting millions of lives in any line of business. We are excited to share this market disrupting platform, HxOne, with the industry.”

One solution, eliminating multiple vendors, and the need to maintain several different systems is an aspiration of many health plans. HxOne supports all types of health plans, including commercial insurance, Medicare, Medicaid, self-funded plans, IPAs, and ACOs. It uses modern technology and is deemed the most advanced claims system on the market. The design is scalable, modifiable, and interoperable to support limitless expansion, sophisticated partner collaboration, timely evidence-based decisions, and superior customer service at a lower cost. HealthAxis invites you to experience the power of one, HxOne.

This month we are speaking to Dhana Leal, Director of Sales Operations about her experience with clients, working for HealthAxis Group, and how she is adapting to a new department during a global pandemic.

How do our health plan clients benefit from working with HealthAxis Group?

We have a lot of offerings that health plan clients benefit from, but what stands out the most to me is our integration capabilities. With HealthAxis Group, clients can have their analytics and data working for them and connect this information through the software and use it to customize service solutions. In my tenure, I have seen a lot of development and improvements. We are constantly evolving to provide our clients and partners with the latest technology to streamline processes.

What has been your most rewarding or satisfying experience with our company?

The most rewarding experience has been to work with so many great teams. This diversity allowed me to learn so much by partnering with individuals who are extremely knowledgeable, proud of their work, and genuinely care about the organization. I find that dynamic to be a huge driver for a lot of the organization’s successes.

Working side by side with Michele Mahoney and the operations team on projects such as Freedom, Optimum, and Cencal taught me invaluable information about the industry. Furthermore, having the pleasure to guide project management operations was an absolute pleasure. That team’s dedication and eagerness to learn and do things the best way possible was a blessing. On the technology side, I also worked with a group of individuals who I consider the foundation of the organization. The passion of these individuals and their hard work is impressive and admirable.

How has your experience been through the Covid-19 remote work transition?

My experience working remotely has been seamless for the most part. I believe it has been a very healthy option for me, saving the daily drive has allowed me to be more productive. Joining a new team in a remote environment could have been challenging, but I have not experienced technical challenges or trouble connecting with people. We use the Microsoft Suite to stay connected, and Teams have proven to be a helpful tool for video calls and file sharing.

I can take a few breaks throughout the workday that I would not have typically taken in the office because I can work as late as I want or need to complete a goal or task. Unfortunately, a pandemic was the trigger for this shift, and I am saddened by that, but I believe the work-from-home effort to be fruitful to those who work better in such an environment, and I happen to be one of those.

Part 3: Analytics Solutions

We complete our series on the most common questions by focusing on our analytics and data solutions. For a quick review, HealthAxis Group offers an array of third-party administrative services that help accelerate productivity, improve processes, and perform cost-efficient operations for Medicare, Medicaid, and commercial plans. We customize service engagements, from outsourcing all plan operations to targeting a single line of service (full list of services).

We understand that choosing a new solution can be a daunting task. To aid in your process, we have compiled the top questions we received from health plans looking for solutions to improve operations and grow membership.

What problems can your solution help us solve?

Our analytics solution is a comprehensive, integrable system enabling full lifecycle analysis. It effectively consolidates and analyzes data into usable and easily consumable information that pinpoints areas for action.

Through our pre-built healthcare Data Model, Data Marts, Intelligence Dashboards, Reports, and Analytics, our system provides hundreds of powerful metrics, alerts, and reports to healthcare professionals. Across the organization, your team can monitor performance, analyze key performance indicators, and compare them to performance benchmarks. Your data will be turned into integrated and actionable insight in near real-time. With Health Intelligence Analytics, you can manage healthcare costs, adopt and become more compliant with new healthcare regulations, improve quality of care, detect fraud, proactively identify high-risk populations and streamline processes.

What type of analytics does your solution offer?

HealthAxis Group’s analytics solution delivers over 200 prebuilt reports and 10 dashboards right out of the box. In addition, the solution allows for customizable and self-service analytics. Providing business users with full ad hoc query and analysis capability, users can create new analyses from scratch or modify existing analyses in dashboard pages.

We provide the ability to turn data into insight using geospatial analytics. Geospatial analytics provide valuable and varied insights into data. The visualizations and interactive geospatial capabilities inherent in our solution are beyond comparison to any like tool. The visualizations deliver detailed analytics in an understandable way that enables the end-users to make informed evidence-based decisions.

Does your solution automate data integration from external/multiple data sources/silos?

Yes, our data architecture consists of several components that enable rapid data intake, standardization, flexible, scalable, and suitable for data warehouse reporting and analytics. Through our best practice standards, we have built an automated data intake facility (DIF) to easily integrate and automate your data integration. The DIF consists of in-depth data file edits, validation routines, and collaborative interfaces with each data source/submitter to expedite resolutions and standardization of these files. The data intake facility allows for sources and/or data submitters to submit the data feeds with a Graphical User Interface (GUI). During the upload of the data feeds, the DIF automatically identifies errors in formatting, data submission, or failures with the upload. The data submitter is notified of errors and/or warnings to know if the data was completely received. The DIF is the beginning of all data intake and integration and all raw files are stored, backed up, and archived so you always have traceability of who submitted what and what was the original format of these data feeds.

Is your product compatible with my existing infrastructure?

HealthAxis Group’s analytics solution is built on an open architecture and is integrable with any infrastructure or environment.

How do you verify data quality?

Quality is regarded as paramount importance at HealthAxis Group. This commitment is demonstrated by the development of our quality management and support systems, which will ensure the quality of our products and services. Through our extensive experience with producing an industry best standard for data validation, we focus on three main areas of the data quality process and strongly believe these areas should be developed and supported by the client to ensure a robust data quality best practice. These are Data Terminology, Data Profiling, and Data Governance.

It is our best practice standard to address the following to ensure the absolute best data quality:

Implement fundamental data quality validation routines, including automated processes to notify database administrators of any data load or quality issues.

Conduct Data Profiling to identify data anomalies and outliers. These quality issues would then be routed to the Governance team for resolution coordination.

Implementation of Data Governance and Terminology Standardization is necessary for data consistency and on-going maintenance and improvement.