Support for Health Plans With Home and Host Capabilities Nationwide
Health plans with home and host capabilities have an opportunity to transform their business to be more agile and flexible than ever before.
As well-established leaders in their markets, many health plans with home and host capabilities require modern technology that can keep pace with their complex business needs. HealthEdge's integrated next-generation solution suite offers flexibility, transparency and enables innovation so they can grow their business.
Health plans with Home and Host capabilities have entrusted HealthEdge’s HealthRules® Payor to remain resilient, competitive, and focused on delivering outstanding service to providers, members and groups nationwide. Home & Host capabilities use inter-plan operations that enable members traveling or living in another plan’s service area to receive their at home benefits while away. Participating providers and independent plans across the country are linked electronically for claims processing and reimbursement. To learn more about why one of these plans teamed up with HealthEdge and how HealthRules Payor helped them navigate the COVID-19 pandemic, click here.
Health plans with Home and Host capabilities are compelled to seek out modern technologies that can keep pace with their complex business needs and support their market-leading positions. Migrating to the industry’s dominant next-generation core claims and administrative platform can play a key role in these technology strategies.
Burgess Source® delivers an integrated ecosystem that brings accuracy upstream in the payment process. The process is fully automated and interoperable, using next-generation technology to create a workflow that incorporates real-time data for truly accurate guidance before payment is made, enabling up-to-date analytics that give health plans current information to shape business decisions.
In 2017, a large plan with Home and Host capabilities in the Southeast implemented a multi-stage rollout of Burgess Source. The core technology was implemented as a centralized ecosystem to consolidate and improve data accuracy for multiple payment integrity functions, including claims editing, pricing, business intelligence, and payment transparency across Medicare Advantage and parts of their commercial product lines. The platform further centralized additional medical policy by including third-party local coverage determination rules and specialty drug rules from third parties. Pleased with the payment integrity guidance and improved efficiency, this client expanded the Burgess Source platform to their newest commercial product offering.
Health plans with home and host capabilities require support for their innovative plans and evolving value-based models, meeting regulations across state lines. GuidingCare® is highly configurable and can seamlessly serve multi-state and integrated organizations with coordinated care and improved member satisfaction.
- Take advantage of new opportunities created by market dynamics
- Respond to competitive pressures
- Ensure compliance with regulatory updates
- Increasing operational efficiency through automating manual processes
- Increase collaboration
- Improve patient outcomes
- Implement new business models
- Provide real-time data and insights that enable transparency inside and outside of the health plan