Collaborative organizations — no matter the industry — are proven to be more effective. How can you tap into this mojo? Your health plan has working relationships with members of other departments, third-party payment integrity service suppliers and providers. By...
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The Value of Collaboration: Find Your Power
Forget the Buzzwords. Lack of progress now doesn’t mean you’ll never catch up.
3 practical steps you can take today if your health plan is feeling left behind on advanced payment integrity technology A few weeks ago, a blog reader approached me about a recent article I wrote titled “Does Your Health Plan Even A.I.?” The reader, who also happens...
Burned out and Bored? Remind Your Employees Why Payment Integrity Matters
Address the “why” behind payment integrity and you’ll find that health plan employees no longer feel stuck. Most talented employees start out in their jobs with a great deal of optimism: meeting new people, learning new things, looking forward to making a positive...
ClarisHealth Achieves HITRUST CSF® Certification to Manage Risk, Improve Security Posture and Meet Compliance Requirements
HITRUST CSF Certification validates ClarisHealth is committed to meeting key regulations and protecting sensitive information. NASHVILLE, Tenn., April 17, 2019 – ClarisHealth, a leading provider of advanced payment integrity technology for health plans, today...
Can your self-built technology solution do this? Why iterative software development is essential.
Health plans considering self-developed payment integrity technology should ask themselves: Do we have the resources to be agile? Iterative Software Development: A cyclical method of software development which focuses on improvements based on continual revisions and...
How to Vet a Third-Party Vendor for Your Health Plan
Pareo® makes it easier than ever to add third-party vendors to your payment integrity operations. Here’s a list of questions to ask new suppliers when interviewing them. A strategic mix of payment integrity suppliers can propel your health plan’s cost containment...
The Power of Saying “I Don’t Know” When You Implement Technology
Your health plan is more likely to adopt new technology if you allow your team the vulnerability of saying “I don’t know” when learning. “I don’t know.” It’s a response that frustrates parents everywhere but also can be one that, in the right conditions, signals...
What Health Plans Need to Successfully Switch to Value-Based Care
Value-based care is not a new concept, and private payers are adopting it more quickly than expected. Still, implementation times could be longer than a year -- and that’s too long. Advanced technology can help. Alternative payment models are expected to reduce...
What’s the problem? How transparency affects problem solving at health organizations.
Implementation of Pareo® begins with a simple question: Why do you do what you do, the way you do it? This question is harder to answer than it appears. Why is that? At the beginning of each and every Pareo® implementation, we conduct a tour of users. A feature of...
Health plan of the future? It starts with data sharing.
Here’s what ONC’s new “information blocking” rule means for your health plan. In February, the Office of the National Coordinator for Health Information Technology (the ONC) announced a new proposed rule to prevent “information blocking.” Interoperability has long...
6 Signs of Outdated Payment Integrity Processes
Working harder and harder for a 1-2% rate of return on claim spend? It’s time to update your health plan’s payment integrity processes. Today, health plans and payers are at a crossroads: margins are shrinking, members are savvier, providers are increasingly...
Status Emails Drain Health Plan Productivity
If your auditors’ workflow depends on email, there’s a more productive way forward. Confession time, health plans: how much of your auditors’ workflow depends upon email? Are they working claims based upon what they were pinged about most recently? You’re not alone....
Top 10 Ways to Maximize Your Health Plan’s Recoveries
Want to maximize your health plan’s recoveries? Of course you do. Here’s how.There’s a great deal of uncertainty in healthcare today, but one thing never changes: health plans’ desire to grow their recoveries. But, stuck dealing with insufficient technology or...
Provider to Health Plan: It’s not me, it’s you.
Are you playing a costly game of “Who’s got the medical record”? 90% of your health plan’s cost containment efforts are the source of provider friction. Your health plan has one directive: control medical spend. And despite tight timelines, a shortage of skilled...
Put on your cape. Your health plan may just save the healthcare system.
Health plans are in a unique position to innovate with a trickle-down effect on providers and healthcare as a whole. It’s the plot to your favorite superhero movie (and with good reason): The odds seem insurmountable, and the path unclear but there’s a hero who sees a...
A Custom FWA Solution for Smaller Health Plans
Out-of-the-box Fraud, Waste and Abuse solutions just don’t cut it for smaller health plans. If you lead a health plan with fewer than 250k covered lives, you may think you’re out of luck when it comes to a comprehensive FWA solution. Some of the larger technology...
Top Trends for Healthcare Payer Technology in 2019
A look at the drivers, restraints, challenges and opportunities for healthcare payer technology in 2019. To view our 2020 industry forecast, click here. It’s 2019: do you know what’s going to happen in healthcare payer technology this year? We’re taking a thoughtful...
Best Practices for Successful Technology Adoption
A look at some of the barriers to successful technology adoption. There must be a method to the madness. New technology solutions appear to be a dime a dozen, and it makes sense to take a modular approach to implementation. At least, that’s what our clients are doing....
Are Your Plan’s Healthcare Providers Happy? Tips on Boosting Your Net Promoter Score
Keeping your health plan’s providers happy will also keep your members satisfied. Here’s how technology can support your net promoter score with providers. “How likely are you to recommend this health insurer to your business associates?” Do you know how the...
Claim Spend – Is It Too High at Your Health Plan?
Examining claim spend cost at health plans, and what kind of ROI can be expected. Controlling claim spend is nearly impossible without system visibility. By that, we simply refer to the access that some technology gives health plans and payers into payment integrity...
Here’s Where Provider-Payer Relationships Need to Improve
Communication breakdowns with providers wreak havoc on a payer’s bottom line. Imagine, if you will, two scenarios in a relationship between a healthcare provider and a health plan. In one, a provider receives a letter from a health plan telling them a claim is...
Addressing the $330 Billion Elephant in the Room: Administrative Complexity
Health plans can minimize wasteful spending on administra Administrative Complexity: Complex administrative processes in healthcare organizations that are increasingly seen as unnecessary and are therefore leading to wasteful spending. Nearly 10% of the $3.3 trillion...
Thoughts on Creating a Centralized Payment Integrity Department
Does it make sense for your health plan to carve out Payment Integrity from your other cost containment efforts into a dedicated department with greater oversight capabilities? Historically, payment integrity efforts have been scattered among specialty departments...
Prepare for CMS Audits: A Guide
Here's what to expect following new CMS payment integrity initiatives, including a guide to CMS audit protocols. The pressure is on for state-administered Medicaid programs (and the MCOs that run them). New initiatives released over the summer by CMS promise increased...
5 Ways Pareo® Benefits Health Plan Vendors
ClarisHealth’s Total Payment Integrity™ solution strengthens vendor partnerships Sooner or later it’s bound to happen: your health plan wants to shake things up a bit. New processes, new technology, new point of contact, bringing new third-party services providers on...
How to Maximize Vendor Partnerships with Pareo®
Payment integrity vendors are critical to the success of any health plan. As health plans realize this, they are working to create stronger partnerships. Here’s how Pareo® helps. We were talking to a health plan recently about our comprehensive payment integrity...
How to Reduce Administrative Costs for Coordination of Benefits
Make Your Processes More Efficient for COB Cost Savings It has been estimated that the administrative costs for coordinating benefits is $800 million. Let that sink in for a second – $800 million is a lot of money to spend on a process that can be improved. Other...
Stop Spinning Your Wheels
How to get your health plan out of a rut and break down big data silos. Health plans are tasked with deriving ever-more savings from their claims overpayment initiatives. But with limited people, strategy, technology or processes to accomplish their goals, are they...
Health Plan Member Satisfaction is the Price of Provider Abrasion
Is provider abrasion undoing all your best member satisfaction initiatives? After a recent medical appointment, I visited the front desk on the way out where the office manager/claims specialist let me know I had an outstanding balance from my preventive care visit...
Grow Your Payment Integrity Efforts with Outsourced Vendor Management
An ideal vendor solution for growing PI departments Building and running a payment integrity department isn’t easy – or inexpensive. There will likely be hurdles along the way, and it isn’t as if the rules around improper payments and claims management are standing...
Escape Your Spreadsheets
An expert guide for health plans seeking to digitize big data and improve productivity in payment integrity and across the enterprise. Spreadsheets are useful and can be a very powerful tool in the right hands. But are they really the best your health plan can do to...
Why Now is the Right Time for Implementation
Total payment integrity implementation can help you right now – even if your health plan is in the middle of a claims system project. You know that old saying, “The best time to plant a tree is 20 years ago. The second-best time is now.”? It’s a similar situation with...
Health Plan Vendors Don’t Have to Be a Hassle … If They’re Well Managed
Gain the oversight you need to manage your health plan’s third-party services providers. Recently, a client shared with us that the IT cost to bring on a health plan vendor was $70k. That stopped us in our tracks. $70k is, in our opinion, way too much for a health...
Payment Integrity in Action with L.A. Care Health Plan
Enjoy our on-demand case study presentation. What does total payment integrity look like once implemented? To answer that question, we invite you to view “Bringing Total Payment Integrity to Light: A Case Study with L.A. Care Health Plan” an on-demand payment...
Don’t Settle for “Just” A Claims Editing Solution
Look beyond claims editing solutions and find a comprehensive solution to payment integrity. If your payment integrity strategy is limited to just a claims editing solution, your health plan is falling short on the payment integrity continuum. Health plans that think...
Smaller is Better
Working with a small provider offers big opportunities for health plans In the world of healthcare, the concept “bigger is always better” often prevails. Superficially, it makes sense that a health plan can mitigate risk by working with a large company that has big...
5 Ways Health Plans Can Leverage Big Data
Health plans, don’t let your data go to waste In healthcare, disruptive innovation lately centers around the Big Data Revolution. And for many established health payers and plans, talk of overhaul can seem overwhelming. Changes trickling in over the last several years...
A Clearer Path to Coordination of Benefits
COB Considerations for Medicaid MCOs Coordination of Benefits. Many Medicaid health plans will tell you that this area is a primary concern in their payment integrity program. It’s no wonder: statistics tell us that 4-8% of Medicaid MCO membership has other healthcare...
3 Considerations When Discussing Technology Change
A discussion guide for Health Plans Would you be surprised to learn that there were prominent naysayers of innovative (and now common) technologies, such as the iPhone, television and even automobiles? Each of these innovations proved revolutionary and have become a...
Fraud, Waste & Abuse is Not Total Payment Integrity
Don’t settle for “good enough” when a better solution exists. Fraud, waste and abuse (FWA) is a serious problem, one that can also be seriously misleading for healthcare payers looking to transform their revenue streams. That’s because many health plans mistake strong...
Maximize Value & Partnership with Your Third-Party Payment Integrity Vendors
Ask yourself these 6 questions to get the most from your payment integrity vendors. Looking to get the most out of your third-party payment integrity solution vendors? Consider asking yourself the following questions to determine if your vendors are providing you with...
What’s your ROI on a Payment Integrity Technology Solution?
Good return vs. bad return on investment and how your health plan can tell the difference When shopping for a payment integrity solution, you will understandably have many questions. Your COO is going to wonder how this software will improve operations, your IT...
4 Reasons SaaS is Your Ticket to Total Payment Integrity
Cloud solutions are more secure than you may realize, and offer intrinsic benefits for health plans. Software as a Service (SaaS) has revolutionized the way technology in business is used. But many health plans are hesitant to rely on SaaS, often because of...
Best Payment Integrity Results at The Most Optimized Cost
Integrative Audit and Recovery Solution Offers Top Value for Healthcare Payers Many of the healthcare companies we speak with often express concern when reconciling the concept of comprehensive payment integrity with day-to-day operational stressors, such as lowering...
Are You Doing Enough to Avoid and Recover Payment Error Leakage?
Most health plans think they have it covered with a claim editing solution, internal payment integrity efforts, or a vendor or two. But what are the real results, and how does that compare to the industry? There’s no doubt that the healthcare industry is in the midst...
By Any Other Name: Sante Analytics Now Known as ClarisHealth
Technology Company Focused on Total Payment Integrity for Health Plans, Providers and Third-Party Administrators NASHVILLE, Tenn., Oct. 2, 2017 – Santé Analytics announced today that they will now be known as ClarisHealth. The change comes as they re-launch their...