Medical Code Clearing House Savings
13
Partnership with Third Party Administrators Proprietary Medical Code Clearing House for TPAs © Copyright 2010 AmeriVeri CR, LLC. All rights reserved. Unauthorized reproduction or distribution prohibited.
-
Upload
julian-pace -
Category
Business
-
view
171 -
download
1
description
Medical Code Clearing House. The AmeriVeri CR team of Hosting, Middleware, Software Engineering, Programming, Database, and Coding specialists has created the most in-depth, fully automated medical code clearing house for verifying the accuracy of health care claims. Based in a Cloud Hosted fully SAS70 Type II certified environment, using proprietary applications for mapping incoming data from virtually any source or software, we are capable of verifying every Group Health, Workers’ Comp, and Medicaid claim in the US, every day.
Transcript of Medical Code Clearing House Savings
Partnership withThird Party Administrators
Proprietary Medical Code Clearing House
for TPAs
© Copyright 2010 AmeriVeri CR, LLC. All rights reserved. Unauthorized reproduction or distribution prohibited.
Situation
By design, the TPA approach is highly flexible. Program components can be replaced
without disrupting the whole –AmeriVeri CR is a perfect “Plug and Play” Partner.
TPAs experience frustration to provide “Discount Proof”
equal to or better than BUCA discounts.
2
Strategies
1. Offset BUCA DiscountsMaximize medical coding accuracy
2. Reduce Health Plan CostsCreate savings on behalf of TPA and Employer
3. Market to EmployersEnhance sales by providing unique product
3
Solution
AmeriVeri CR finds an average of 4%additional savings after all verification
methods currently in place.
4
Partnership
AmeriVeri CR works with you:– On behalf of the Self-Funded Employer– To maximize coding accuracy– And find additional savings
TPA
Provider
Employer
AmeriVeri CRAmeriVeri CR
5
Code Verification
• AmeriVeri CR system databases updated as changes to the code occur
• Proprietary software verifies:
• AmeriVeri CR does not verify Benefits
6
TPAs generally provide much better reporting than BUCA; more flexible with more detail. AmeriVeri CR enhances reporting.
About AmeriVeri CR
AmeriVeri CR is accountable– TAT (quick turn around time)– Quality of service/producer– Problem resolution
It is OK to brand the AV CR program asTPA or Employer, or to blind market.
7
Technology
• SAS70 Type II Certified– Secure hosting facility and redundancy
• HIPAA Compliant– All policies and procedures
• Cloud Hosted Virtual Servers– Scalable platform for high capacity processing– Recently processed 975k claims in under 22 minutes
• Data Transfer via SFTP– File feeds scheduled at convenience of TPA
8
“Plug & Play” Solution
Claims Adjudicated by TPA
Claims Prepared for Final Processing
TPA Completes Claims Processing
AmeriVeri CR Identifies Savings
Batch Returned to TPA
AmeriVeri CR
YES
NO
Steps 1-3 represent current process
Steps 2a-2b represent AVCR process
1
2
3 2b
2a
9
Savings Distribution
• AmeriVeri CR identifies code errors after all current verification methods
• Identified Savings Distribution:• 75% to the Client• 25% to AmeriVeri CR
10
Verification Example
• Annual Claims Processed$200,000,000
• AmeriVeri CR Savings @4% $ 8,000,000
• 25% to AmeriVeri CR $ 2,000,000– Includes all processing, service, and appeals
• 75% to Client $ 6,000,000
11
Next Steps
1. Configuration Meeting– Review and execute agreements– Introduce IT managers
2. Activate AmeriVeri CR Program– Schedule date to begin service
3. Create Savings
No Cost to Test or Initiate ServiceAll forms and agreements provided for review
12
Contact
13
AmeriVeri CR, LLCJulian PaceBusiness Development DirectorOhio Valley RegionOffice 888-354-8776, ext 723 www.ameriveri.com/cr [email protected]
