A Factual basis for Payers and Providers to mutually reduce administrative costs and improve performance

With consumerism and interoperability initiatives reshaping the business of healthcare can the traditional walls between payers and providers still exist? How can payers and providers leverage their rich data sources to collaboratively manage costs when there is no common perspective? MedeFinance is uniquely qualified to address this challenge by objectively aggregating and "intellectualizing" disparate data sources and delivering it in a secure neutral environment allowing for transparency and credibility. As the data analytics middleman, MedeFinance delivers the complete data picture and analytic tools necessary to manage performance between healthcare stakeholders.

Solution Service
MedeFinance delivers a neutral technical environment that enables providers and payers to share data and analytics that are essential to effectively reduce costs, improve cash flow and planning certainty in the delivery and payment of healthcare services. We track the lifecycle of the claims billing and payment process from start to finish. This end-to-end view facilitates reconciliation, identification of problem areas and provides timely actionable insight.

The value of patient account and claims reconciliation
Today both providers and payers understand their portion of the claims process very well. However, once the claim is out of their hands, there is little, if any, knowledge about the other party’s process, timeline or expectations. By reconciling the provider’s accounts receivable with the payer’s claims payable, CPAS can provide information that has never been shared and allow both organizations to amend current practices that are incorrect or unnecessary.
Once a credible and neutral data set is established between stakeholders not only claims billing and payment analytics but additional data and performance standards in medical management, anti-fraud and regulatory compliance can be managed collaboratively.

• Improve administrative performance
• Faster turn-around-times
• Greater payment accuracy
• Fewer interest and penalty payments
• Lower total interactions per claim
• Improve reserve and risk planning certainty
• Early visibility into potential appeals and catastrophic claims
• Avoid legal battles
• Reduce denials and credit balances
• Increase contractual compliance
• Strengthen working relations for more favorable contractual terms
• Transition from a reactive to a proactive approach to issue resolution
  

“Creating a collaborative information environment will change how organizations compete and help enable them to become more agile. Therefore, payers must alter their perspective on information and business intelligence”

   —  Gartner October 5, 2005

“The age of transparency will revolutionize business”

   —  Don Tapscott and David Ticol – The Naked Corporation

“The word naked can mean exposed and not many businesses enjoy that thought. But times are changing fast and candor and transparency will be essential foundations of trust; and that trust will be the key ingredient of success. Any corporation failing to heed that message may find itself exposed indeed.”

   —  Sir Martin Sorrell, Chairman and CEO WPP