Benefit & Contract Modeling
With HealthRules Payor, health plans can model proposed benefit plan and provider contract changes by first configuring retroactive updates in a test environment that has been populated with relevant production data. Industry-leading reprocessing capabilities then automatically re-adjudicate all claims affected by the changes, and the financial impacts at both individual claim and overall summary levels are displayed. Detailed information on both original and reprocessed versions of claims is captured in the HealthRules Answers real-time data warehouse, driving sophisticated reports that summarize the effect of the configuration changes based upon the plan’s historical data.
Health plans must shift their business models to embrace empowered consumers by consistently offering the best, most competitive services, and benefits.
Download this case study to learn how HealthEdge helped AmeriHealth Administrators quickly bring a new benefit plan to market and serve new customers.
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HealthRules Payor allows health plans to design and implement any type of benefit plan or provider contract
HealthRules Payor network design options are highly flexible to support easy and rapid configuration