Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
The client is a Health Tech company offers product and solutions to the US Health Plans, Providers, and Hospitals.
We have developed a solution to meet the CMS two final rules on the hospital price transparency and coverage transparency. The new system will help providers and patients to understand the costs, providers to check the accuracy of the charges, analytics on the pricing to maximize revenue and intelligence platform for denial management.
We have developed a solution to meet the CMS two final rules on the hospital price transparency and coverage transparency. The new system will help providers and patients to understand the costs, providers to check the accuracy of the charges, analytics on the pricing to maximize revenue and intelligence platform for denial management.
Client Need
Enhancement and development related to Pricing transparency can be useful for the patient so that there would be transparency in the prices and can be accessible during the changes in prices or any details related to facility, payer, plans to patient
With Pricing Analytics, Denial Intelligence and Charge Accuracy solutions provided, facilities and physicians can maximize their net revenue and can sustain in the competitive market
Solution
An interface to facilitate the Pricing transparency which offer more transparent prices to patients for the items and services they provide. Publish Excel reports with validations for the data present for CDM standard charges and shoppable services which include all the facility, payers, plans information
An interface uses by the providers to measure the Charge accuracy of provider so they can identify and correct errors to ensure compliance and optimize net revenue. Using claims data (HCPCS, revenue codes, ICD-10, etc.) submitted to payors
An interface which helps providers to describe accurately marketing, financial and internal pricing strategies and priorities
An interface which helps provider to generates a rich set of Denial Intelligence reports on all claim and remit activity and allows to admins to act up on and take action against the denial which has biggest impact on their revenue loss
Realized Benefits
RCA provides different solutions that enables providers to optimize revenue cycle performance. It helps providers to view their current pricing strategy where it stands in the current market, compare, identify any issues and finally resolve them to get maximum benefit for their revenues
Tools & Technologies
Java
RabbitMQ
PostgreSQL
Ext JS
Drop Wizard
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