Medica needed to rapidly expand in eight states and teamed up with HealthEdge for infrastructure support, and codeveloped the tool to control and simplify administrative processes, and to save on time and costs, the companies said in today’s announcement.
Working with Burlington, Massachusetts-based HealthEdge’s administrative-processing platform for payers, the new HealthRules Promote leverages automation to update validation policies, modify fee schedules, restructure benefit plans and launch new lines of business, the company said.
“For us, HealthRules Promote has been a game changer,” Robb Tushie-Lessard, manager of configuration architecture, quality and business analysts at Medica, added.
“We are 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 our commercial plans onto the HealthRules Payer platform, we experienced zero configuration issues,” he said.
Health plans, which generally have complex offerings across multiple lines of business, can compare configurations and move changes from testing to production environments without the need for IT support. An audit trail tracks changes automatically.
THE LARGER TREND
Last week, HealthEdge released results from a survey of more than 2,800 healthcare consumers in the U.S. on member satisfaction, trust, communication, the rising costs of healthcare and more, and found that 40% of its respondents blamed health insurance companies for the high costs of healthcare delivery.
Healthcare payers regularly look to automation technologies, analytics and artificial intelligence to reduce costs and administrative burdens.
Companies like the Seattle-based Outbound AI are looking to AI to augment human talent, from reducing claims and billing burdens to moving prior authorizations forward.
Cohere Health is using machine learning to look at patient needs beyond a single transaction and make the prior auth process faster for patients, explained Niall O’Connor, chief technology officer.
“We try to use the totality of information about a member and a provider to accelerate decision-making,” which uses ML and modeling approaches to look at claims data and uses natural language processing, aided by deep learning approaches, to extract key information from the clinical narratives payers receive, he told Healthcare IT News earlier this month.
While novel techniques are used to make the approval process faster and more efficient, denials are not automated, he added. Watch the reset of the interview below.
ON THE RECORD
“HealthRules Promote makes health plans nimble and resilient to member, provider, regulatory and competitive pressures in the ever-changing healthcare landscape,” said Alan Stein, chief commercial officer of HealthEdge, in a statement.
“The solution provides unprecedented configuration and promotion integrity.”
Andrea Fox is senior editor of Healthcare IT News.
Healthcare IT News is a HIMSS Media publication.