Source Launches Retroactive Change Manager

The first tool to automate repricing of claims, variance reports for over and under payments and monitoring of retroactive changes 

Today, payers looking to reconcile inaccurate payments rely on laborious manual processes, multiple (and disparate) vendor solutions, and toggling between multiple interfaces—resulting in inefficiency and waste.

Source’s Retroactive Change Manager alleviates these issues by automating:

  • Monitoring of retroactive changes
  • Reconciliation of inaccurate claims
  • Repricing of claims by payers
  • Variance reports displaying all claims needing adjustment and by how much

With this tool, payers can manage pricing, editing, configuration and policy updates internally from a single API.

For all retroactive regulatory updates, the Retroactive Change Manager automatically reprices affected claims. For configuration updates, users can run ad hoc jobs and reprice affected claims.

Additionally, no other vendors currently offer flagging of under payments to providers. By addressing under payments health plans will decrease provider abrasion and become more compliant with CMS audits.

The Retroactive Change Manager is deployed within minutes and seamlessly integrates into current claim adjudication processes. Health plans can continue to reprocess and adjudicate claims using their current methods requiring no additional resources or attention from internal teams.

How is the Retroactive Change Manager different from current retroactive solutions?

1. Comprehensive Pricing and Editing Management in 1 Platform 

All claim pricing and editing activities are conducted in 1 cloud-enabled platform. This allows for an optimized user experience without toggling between interfaces. It also automates content updates into a single environment, to eliminate time-consuming and costly manual updates to multiple software solutions.

2. Identification of Underpayments 

For health plans, identification of under payments prevents provider abrasion and helps maintain compliance with CMS. Vendor solutions working off contingency models are disincentivized to offer underpayment flagging simply because it is not as profitable to them.

3. Automation: Requires 0 Lift from Internal Teams

The unique automation capabilities of Source conducts optimized contract management without any internal lift from health plan teams.

Why haven’t health plans leveraged automated claims variance reports before now?

Any claims automation activities built in-house require significant upfront capital, time, and resources, which leads health plans to often outsource these activities to vendor solutions. But vendor solutions have traditionally focused on the most profitable activities to them: retroactively chasing payments.

Today, however, payers are realizing the benefits of prospective payment integrity, and understand that to achieve long-term payment integrity goals, they must invest in cloud-enabled, single-API solutions that enable productivity and provide complex business insights.

Payers are demanding more from their vendor solutions—and rightfully so. Equipping payers with the tools they need to improve provider relationships and member experience begins with delivering authentic transparency into the inner workings of claims IT ecosystem.

Will this technology cause current IT systems to run slower?

Source ensures health plan IT systems will continue to operate as efficiently as before.

Repricing happens off internal production servers.

Activities are also strategically scheduled for when IT systems have greater bandwidth.

In addition, health plans can customize how often reports are run, permitting scheduled and ad hoc reporting.

How long will implementation take?

For current Source clients, full implementation takes under an hour and requires no effort from your internal teams.

When will this tool be available?

The Retroactive Change Manager will be available in Q4 2022.

About the Author

Carl Anderson

Carl Anderson, Senior Solution Manager - Payment Integrity
LinkedIn
canderson@healthedge.com

Carl Anderson is a Senior Solution Manager – Payment Integrity with 8 years of experience across multiple intervention points. He has spent years deep in the weeds of payor’s data, systems, and policies gaining a deep understanding of the complexities of healthcare reimbursement. He has seen up close and personal what goes right and wrong – which helps drive Health Edge to root cause solutions rather than a short-term fix.

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