Change Healthcare And Pegasystems Connect Claims Payment Systems

Change Healthcare and Pegasystems Connect Claims Payment Systems

  • August 1, 2017

Change Healthcare announced today that its ClaimsXten and ClaimsXten Select now interoperate with Pegasystems Claims Processing, helping payers ensure fast, accurate payment in compliance with internal and CMS medical policies and guidelines—all within their familiar Pegasystems workflows. Read the news release

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Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 8, 2017

The health care industry’s claims payment system is frustrating, inefficient, and prone to errors, according to a new Op-Ed in Morning Consult. But Amy Larsson says one way to overcome these challenges is to start automating disparate payment systems to reduce manual interventions and thus the errors they might introduce. 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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Four Steps To Develop, Implement, And Operationalize A Bundled Payment Strategy

Four Steps to Develop, Implement, and Operationalize a Bundled Payment Strategy

  • February 17, 2017

By Andrei Gonzales, M.D. In the continuing effort to increase quality and decrease costs, health plans and providers are shifting from volume-based care (fee for service) to a value-based reimbursement structure (fee for value). Value-based reimbursement promises benefits to patients, providers, and health plans, as it encourages delivery of high quality care at the lowest cost, largely by improving clinical and administrative efficiency.¹ This paradigm shift to value-based reimbursement creates increasingly complex reimbursement scenarios for health plans. According to a “Journey to Value” study Change Healthcare commissioned, an overwhelming 97% of health plans and 91% of hospitals are now deploying…

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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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Journey To Value: The State Of Value-Based Reimbursement

Journey to Value: The State of Value-Based Reimbursement

  • June 13, 2016

There's no turning back from value-based care and value-based reimbursement. Payers are 58% along the continuum to VBR, up from 48% in 2014. And Providers are now 50% down the road to value. That's according to a national study of 465 payers and hospitals conducted by ORC International and commissioned by Change Healthcare. Yet despite tremendous growth in capitation/global payments, pay for performance, and episode of care/bundled payments, many payers and providers still face obstacles in the transition to value-based care. See where healthcare stands in its journey to value and what it means for the industry in Journey to Value: The…

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Five Steps Payers Can Take To Make Provider Directories Accurate

Five Steps Payers Can Take to Make Provider Directories Accurate

  • April 14, 2016

It’s time to fix this problem and get it right as an industry. That might mean revising our business processes or rethinking the way we use technology. By Michael Flanagan Health plans that have been using quick fixes to update provider directories are facing an unwelcome wake-up call: fines that can range up to $25,000 per day per beneficiary. Moreover, payers found in violation of the Centers for Medicare & Medicaid Services (CMS) rules can be banned from new enrollment or marketing. These penalties are specific to Medicare Advantage programs and policies sold through Healthcare.gov, but they are emblematic of…

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