InterQual Connect Helps Partners Automate, Streamline Reviews For Providers

InterQual Connect Helps Partners Automate, Streamline Reviews for Providers

  • October 3, 2017

A growing number of healthcare technology vendors are streamlining preauthorizations by integrating the InterQual Connect cloud-based interactive medical review and connectivity solution into their own offerings. Most recently, InfoMC and HealthTrio both announced they are integrating InterQual Connect with their own solutions to automate exception-based utilization management for their provider customers. InfoMC, a provider of cloud-based healthcare management and care coordination solutions, has integrated InterQual Connect into its Incedo Healthcare Management System. The integration will support a more efficient, standardized clinical review process by allowing care managers to easily access care guidelines from within the Incedo decision-support workflow. HealthTrio, which…

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Claims Processing Interoperable

Claims processing interoperable

  • August 2, 2017

Change Healthcare announced that its ClaimsXten™and ClaimsXten™ Select claims auditing solutions are now both interoperable with Pegasystems Claims Processing, McKnight’s reports. Read the article

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Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 6, 2017

By Amy Larsson RN, BSN, MBA The U.S. healthcare industry’s claims-payment system is frustrating to providers, payers, and patients alike. Inefficiency and a systemwide tendency for error wastes precious resources, worsens miscommunication and mistrust among all stakeholders, and inhibits the ability to transition to value-based approaches that achieve better outcomes. We need to rethink our industry’s disjointed and siloed approach in order to solve a very integrated problem. Despite billions invested in achieving efficient claims payment, more than 7% of claims are not paid correctly the first time, the second time, and sometimes even the third time.¹ The remediation process…

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Reinventing Utilization Management To Bring Value To The Point Of Care

Reinventing Utilization Management to Bring Value to the Point of Care

  • June 6, 2017

How an automated exception-based approach can make UM more efficient and effective By Nilo Mehrabian How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models). Providers and payers must operate across a transparent, administratively simple, shared ecosystem. This giant leap from today’s world in which healthcare stakeholders currently operate might…

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Two New Federal Interoperability Rules: What You Need To Know

Two New Federal Interoperability Rules: What You Need to Know

  • January 12, 2017

By Lisa P. Conley, Esq. Payers and providers are increasingly vocal about their need for health information technology (HIT) systems to interoperate in a consistent and industry-wide manner. While the industry has made progress on this front, recent actions in Washington aim to accelerate the pace of progress while also demonstrating the government’s commitment to HIT interoperability. On October 14th, 2016, the federal government announced two final regulations that impact the ongoing transformation to “full interoperability” in healthcare. One regulation was the nearly 2,400-page final rule from the Centers for Medicare and Medicaid Services (CMS) on implementation of the Medicare…

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From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

A bundled payment program built by hand 25 years ago is still delivering lessons for HIT today By Amy Larsson The evolution of healthcare IT systems seen by industry visionaries sounds great. Siloed clinical and insurance systems get connected and can work as one. Information-rich processes flow smoothly and securely over connected services that span care settings, providers, and payers. We gain leaps in efficiency, quality, and accuracy of care coordination, delivery, and payment systems. And as healthcare evolves in its journey to value, we snap clinical and payment services together like the related pieces of the healthcare puzzle that…

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

How interoperability unlocks silos in enterprise applications and connects the business logic needed to support value-based reimbursement By Michael Wood Interoperability is about more than just moving data from one application to another. It’s about easily and seamlessly capitalizing on the business logic that is locked within separate—and often siloed—applications to create new capabilities that can solve business problems in a unique way. Today, interoperability must occur both within the four walls of a payer or provider’s IT infrastructure as well as within or between on-premise, off-premise, cloud, hybrid, and other hosting approaches in a manner that appears to be…

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