Monthly Archives: December 2014

Short-Term Savings are Paramount to Payers

Because of the artificially high turnover rates that exist in the current workforce environment created by our long-standing weak economy, self-insured Payers are not always interested or open to long-term ROI programs like Wellness and Disease Management. These have always been more difficult to sell based on ROI. The same is true for Medical Healthcare Plans, who are typically seeing a 20% to 25% turnover in their membership each year. The long-term efficiencies of these types of programs just are not what Payers are currently focused on.

SHORT-TERM SAVINGS ARE KING.

Technology products and services providing measurable, short-term savings in the next twelve to eighteen months are at the top of most Payers’ lists. Things like telemedicine, mobile apps for everything from diagnostics to benefit services, real-time web portal services for online administrative functions, and the process automation of administrative services all translate into short-term savings on both the provider services and administrative services side of the healthcare process.

BOTH SIDES OF THE AISLE ARE IMPORTANT

On the Provider side, reducing time in the hospital through improved surgical outcomes, expediting diagnosis, and effectively managing certain chronic illness at home through remote patient monitoring all contribute to reducing the cost of healthcare. Connecting health technologies to improve patient compliance and reduce office visits all combine to provide an attractive ROI in the short-term.

On the Payer or administrative side, comprehensive software systems, which streamline the eligibility and claim payment process flow through flexibility and automation, will eliminate redundancy and the expense of needing multiple, more singularly-focused functionality platforms. This contributes significantly to the reduction of variable overhead costs and the risk of errors related to duplication of effort and unnecessary data integration.

RESISTANCE TO CHANGE

Unfortunately, the reluctance to change and to embrace new technology results in the desire to maintain the status quo, which by today’s standards, is unacceptable. As with all technological advances like the internet, there will continue to be an acceleration, which you need to be a part of if you want to remain relevant.

VBA Software November 2014 Release Notes

BENEFIT SERVICES
  • Made some cosmetic changes to the layout of the Plan Maintenance screen. Rather than piling all plan information into a single screen, there are now two tabs that hold the plan settings.
  • Plan Definition – The Plan Definition tab holds all the basic information of a plan including: Description, Plan Type, Annual & Lifetime maximums as well as Deductible, Co- Insurance and Out of Pocket limits.
  • Plan Options – The Plan Options tab holds the additions plan settings specific to certain lines of business such as Disability, Life and Flex.
  • Added the ability to define Context 4 Healthcare connection information by plan. This allows for flexibility with the Context4 system when claims are submitted for edit.
  • Removed the Plan Notes fly-out. This paradigm is no longer used throughout the application and will be phased out over the next several releases. Notes are still accessible through right-click View/Add Notes with no change in functionality.
BILLING SERVICES
  • Added logic when creating self-admin invoices to look at Effective Date and Term Date on the Group Volume record to determine the volume. Before this change, multiple Group Volume records were being added together.
CLAIM SERVICES
  • Added the ability to file a grievance directly from a Paid Claim. Selecting the “File Grievance” option will prompt the user to select the source of the Grievance (Provider or Member). This provides a shortcut for grievance filings where the hook to claim and source entity are already prefilled upon creation of the grievance.
ENROLLMENT SERVICES
  • Added a number of additional options to the PCP Auto-Assignment process to allow for more restrictive and accurate assignment of eligible PCPs to eligible members.
GROUP SERVICES
  • Updated Payment Activity detail screen to include data from Self Admin invoices.
PROVIDER SERVICES
  • Added NPI to the Payee screen. This will allow for easier maintenance and viewing of that information without the need to bring up the ID Codes screen.
  • Added NPI to the Payee Search criteria.
  • Added the ability to enter the age of patient being accepted by a particular Provider. These new fields affect PCP Auto-Assignment but can be used for informational purposes and reporting if necessary. The Age range is only visible when a Provider is flagged “Accepting Patients”.
  • Added the ability to define a Provider Withhold. This withhold amount is taken after all benefit and plan calculations and affects the payable amount directly. The withhold amount is taken from the first instance meeting the criteria for a specified service line. A withhold defined with a Benefit Code takes a higher priority than not defining a Benefit Code (which indicates a withhold for all benefits).
REINSURANCE SERVICES
  • Removing a payment from a reinsurance transaction will now void the receipt.
USER SERVICES
  • Users can now create a User Limit of type Total Payable. This amount will be compared to the total of all claim detail payable amounts on a claim.
  • For Amount Limits, we moved the Procedure From and Procedure Thru columns to their own detail table. This improves readability and eases the maintenance of Amount Limits (Image 3).
VBA Control Panel
  • Added the ability to define the default Context4 Healthcare connection information. This default connection setting is used when not connection information is defined by the Plan. In the event that no connection information is entered at the Plan or the Control Panel, a default configuration setting is used based on initial implementation values. IF YOU ARE INTERESTED IN THE CLAIMS EDITING CAPABILITIES OFFERED THROUGH CONTEXT4 HEALTHCARE AND HOW TH IS PRODUCT CAN SAVE YOUR CLIENTS MONEY, PLEASE CONTACT VBA FOR DETAILS AND PRICING.
VBAdjudicate
  • Added the adjudication rule for Provider Withhold. This rule takes place after benefit and plan calculations, maximums and accumulators so that only payable amounts are reduced by the amount withheld. This rule is only fired if Provider Withhold information is populated.
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