By partnering with the Minnesota-based nonprofit Medica health plan, HealthRules Promote enables analysts to test configuration changes in minutes through an easy-to-use web-based interface.
why does it matter
The companies said in today’s announcement that Medica needed to rapidly expand into eight states and partnered with HealthEdge to support infrastructure, develop a tool to control and streamline administrative processes, and save time and costs.
Working with HealthEdge management processing platform in Burlington, Massachusetts, the new HealthRules Promote powers automation to update validation policies, adjust fee schedules, restructure benefit plans, and launch new lines of business.
“For us, HealthRules Promote was a game changer,” added Robb Tushie-Lessard, Medica’s director of composition engineering, quality, and business analysts.
“We’re able to empower our multi-user environments with the tools they need to implement new configurations with greater confidence and fewer issues. When we recently rolled out our business plans on the HealthRules Payer platform, we didn’t experience any configuration issues,” he said.
Health plans, which generally have complex views across multiple business lines, can compare configurations and move changes from test environments to production environments without the need for IT support. An audit trail that tracks changes automatically.
The biggest trend
Last week, HealthEdge released results from a reconnaissance More than 2,800 U.S. healthcare consumers surveyed member satisfaction, trust, communication, rising healthcare costs and more, and found that 40% of respondents blamed health insurance companies for the rising costs of providing healthcare.
Healthcare payers are regularly looking at automation, analytics, and artificial intelligence technologies to reduce costs and administrative burdens.
Companies like Seattle-based Outbound AI are looking to AI to augment human talent, from reducing claims and billing burdens to driving forward pre-authorizations.
Cohere Health uses machine learning to look at patient needs beyond a single transaction and make the pre-authentication process faster for patients, explains Niall O’Connor, chief technology officer.
“We try to use aggregate information about the member and the provider to speed up the decision-making process,” which uses machine learning and modeling methods to look at claims data and uses natural language processing, aided by deep learning approaches, to extract key information from the clinical narratives its payers receive, he said. Healthcare Information Technology News earlier this month.
He added that while new technologies are being used to make the approval process faster and more efficient, the denial is not automated. Watch a replay of the interview below.
On the record
“HealthRules Promote makes health plans resilient and resilient to members, providers, and regulatory and competitive pressures in an ever-changing healthcare landscape,” Alan Stein, HealthEdge’s chief commercial officer, said in a statement.
“The solution provides unprecedented configuration and merchandising integration.”
Andrea Fox is Senior Editor, Healthcare News for IT.
Email: afox@himss.org
Healthcare IT News is a publication of HIMSS Media.