At 成人视频, we see bending the healthcare cost curve as not only identifying medical savings to lower costs across the healthcare ecosystem, but also supporting the value of care for patients. Our role reaches far beyond just saving dollars and cents鈥攅verything we do supports the long-term goal of enabling affordable care for all.  

With costs continually rising across the board鈥�. Consumers are having difficulty paying their medical bills. Providers are pushed to seek rate hikes and higher reimbursements, and employers face a . Payors combat double-digit pharmacy trends . And no one escapes the . 

成人视频鈥檚 suite of services leverages sophisticated technology, data analytics, and a nationwide team that strives to bend the healthcare cost curve every day. Here鈥檚 how we do it:  

Analytics-Based 成人视频

We identify and negotiate fair out-of-network provider reimbursements and help to eliminate balance bills. 

Data & Decision Science 成人视频

By delivering actionable, digestible data, we enable next best decisions to lower healthcare costs.  

Network-Based 成人视频

成人视频 contracts with over 1.4 million healthcare providers and facilities to support our clients鈥� network-access strategy.鈥�

Payment & Revenue Integrity 成人视频

To combat waste and abuse, we identify claims errors, improve payment accuracy and prevent overpayments. 

成人视频 Payments

Our payment solution, manages the process from start to finish, supports the 1099 lifecycle and handles EOBs and creation and distribution of ID cards. 

End-to-End Surprise Billing 成人视频

We administer the entire No Surprises Act process on your behalf, negotiating to avoid arbitration, building complementary networks or determining the appropriate payment amount.

The infographic below provides a snapshot of how 成人视频鈥檚 solutions identify potential savings, lower out-of-pocket costs for members and patients, and help eliminate balance billing for millions of healthcare consumers. We walk the walk when it comes to bending the healthcare cost curve.

Ready to talk? Email us at connect@multiplan.com.

The US healthcare system is struggling with spiraling costs and often patients bear the burden. The No Surprises Act legislation was enacted to help protect patients from balance billing. In 成人视频鈥檚 latest report healthcare payors and providers respond to the new No Surprises Act regulations. Payors and providers are aligned that the No Surprise Act is a positive step toward helping patients from experiencing unexpected costs and could improve perceptions of the healthcare industry as well.

成人视频鈥檚 survey results show many healthcare payors and providers respond to the impact of the No Surprises Act with an optimistic outlook, including its potential to drive positive change for patients. Despite differences leading up to the implementation of the No Surprises Act, payors and providers agree it will deliver greater transparency for patients. 

However, though leaders see NSA as a positive driver, payors and providers know it is one of many steps needed to address the ails of the US healthcare system. In addition, both face challenges with implementation of the No Surprises Act and will require major process changes. 60% of leaders anticipate difficulty with meeting the tight timelines of the open negotiation and IDR process, with 62% reporting the NSA creates an undue administrative burden for their organization.

As a catalyst for innovation and collaboration, healthcare leaders believe NSA will ultimately help spur digital solutions, with a strong reliance on data, with 50% agreeing NSA will drive innovation and 48% reporting the No Surprises Act is likely to foster more cooperation on pricing issues between parties.

While there is no doubt the No Surprises Act adds a new level of complexity to paying healthcare claims, it isn鈥檛 new to 成人视频. Well before the NSA became law, 成人视频 supported clients with similar services for years, such as negotiation to avoid arbitration, building complementary networks, and determining appropriate payment amounts that are fair for all parties. 成人视频 is now leveraging its expertise to offer organizations end-to-end Surprise Billing 成人视频 and customizable solutions for every step of the process to help its healthcare industry partners quickly achieve and stay in compliance. 

The data reported is based on the findings from survey which polled healthcare payor and provider executives at the Director level and above, who had strong familiarity with the NSA. The survey was conducted by Questex in December 2021 on behalf of 成人视频.

Due to many complexities in the healthcare industry ranging from data privacy to emerging mandates and compliance to complex provider/payor networks, plus member/patient needs and considerations, it can be challenging to balance complexities with innovation. But 成人视频 is doing just that with its award-winning negotiation prioritization tool, recently selected as the 鈥淗ealthcare Data Solution of the Year鈥� by Data Breakthrough and a winner of the prestigious 2022 CIO 100 Award. 

The Challenge

成人视频 recognized its negotiators needed a tool fueled by machine learning to streamline claims before they reach the negotiator鈥檚 desk. By gauging internal capacity and current processes, the data team considered criteria such as the claim due date and the last time each claim had been touched in determining a solution.

When determining the type of tool to build, 成人视频 factored in the negotiators鈥� current process 鈥� i.e. they would receive between 100 and 600 claims each day and had to decide which to work first. They could carry as many as 1500 claims in their work queue at times. Prioritizing which to work first was time-consuming and required negotiators to review provider history at the claim level to estimate the amount of potential savings and to determine which claims would have the greatest likelihood of a successful negotiation.

Each negotiator had their own method to decide what was ‘most important’ and ‘most probable for success’. They spent hours each week sorting their queue as claims were worked and new claims came in. The process was frustrating and had variable success based on the negotiator鈥檚 experience and their ability to identify patterns for a successful negotiation. Moreover, time spent prioritizing the negotiation queue was time spent not negotiating claims. 成人视频 saw an opportunity to make the process more efficient.

The Solution

成人视频 developed a negotiation prioritization tool aimed at helping negotiators streamline their workflow and quickly identify the next best claim to work. The team conceived and deployed a highly effective internal tool that immediately delivered on enhancing productivity.

The negotiation prioritization process uses a combination of machine learning and business rules to provide an optimized order for negotiators to work claims. Machine learning calculates a claim score based on two key factors; Savings, the estimated savings that will be achieved on a claim, and Success, the probability of successfully negotiating a claim. The machine models make use of the financials of a claim, its clinical factors, 成人视频’s history of negotiating with a particular provider, and claim data elements submitted by clients to assign a claim priority score that is used to automatically rank claims within the queue. Even the most experienced negotiators could not examine all the factors that would result in a successful negotiation, whereas the model can and is highly predictive. 

When building the tool, 成人视频 also accounted for operational requirements. Five key business rules work alongside the machine model to balance business needs with success factors. The tool considers criteria such as the claim due date and the last time each claim had been touched. By combining these rules with the machine model, the team is able to deliver successful outcomes for all claims, not just those deemed best opportunities by the machine model. Business criteria can be customized based on evolving needs, making the tool a flexible solution that can evolve as needed.  

Beginning with its team of 350+ claims negotiators, 成人视频 quickly launched and implemented its negotiation prioritization project to streamline workflow, drive efficiency and increase ROI. Using machine learning to rank claims with the highest potential for success, negotiators were given a clear roadmap, cutting down on wasted administrative time and significantly increasing productivity and yield.

By advancing machine learning techniques around payor/provider fee negotiation in a hybrid cloud environment, the company is playing a critical role in helping:

• Drive down patient/member costs in healthcare.
• Find new ways to deploy machine learning and data science techniques to solve complex fee and reimbursement challenges. 
• Improve operational efficiency and effectiveness (both in time and in dollar savings) for teams and departments across business and operational lines at 成人视频. 
• Maintain a market leadership position in payor cost containment and payment/revenue integrity. 

In the long run, 成人视频 clients benefit when the fee negotiations team is more productive in prioritizing work. Paired with 成人视频鈥檚 innovative solutions tailored to meet each client鈥檚 individual needs, this is a win/win for all involved.聽

CIO 100 Award

CIO Magazine named 成人视频 a CIO 100 award winner for its negotiation prioritization project that implemented advanced machine learning techniques to streamline this high-touch area of its business, generating greater customer value while improving efficiency. For more than 30 years, the from CIO Magazine have recognized innovative organizations around the world that exemplify the highest level of strategic and operational excellence in IT.

Data Breakthrough Award Winner

Named the 鈥淗ealthcare Data Solution of the Year鈥� award in the annual Data Breakthrough Awards program conducted by , 成人视频 was specifically recognized for its negotiation prioritization tool that helps its claims negotiators quickly identify the next best claim to work, leading to greater savings for customers and increased throughput for negotiators. The annual Data Breakthrough Awards is the premier awards program founded to recognize the data technology innovators, leaders and visionaries from around the world.

When eligibility errors occur, they affect many payment integrity areas such as coordination of benefits (COB), subrogation, and Medicare secondary payer (MSP) validation. Failing to address these issues leads to incorrectly paid claims, improper reimbursements, or claims that shouldn鈥檛 be paid at all鈥攃osting your health plan millions.

This infographic identifies the top three causes of eligibility errors and illustrates how a connected payment integrity approach can help.

Interested in learning more about eligibility data and how a connected payment integrity approach can help? Contact us today!

Previously published on the former Discovery Health Partners website.