Responding to the scope and volume of payer interactions can be overwhelming. Investigating and resolving charges on even a single claim can require an exponential number of EDI transactions between parties. Repeat that effort for all your payers – government, health insurance, and self-payers – and it’s no wonder effective payer management is an important strategy for enhancing your financial performance. What if it were possible to break the pattern by profiling payers’ common disputes for claims, and make pro-active adjustments to prevent denials instead of reacting to them?

MedeFinance Payer Profiling Analytics is an on-demand, always-available analytic service that offers unmatched profiling of payer trends, patterns, and adjudication outcomes so you can identify process improvement opportunities and stop revenue leakage fast. Payer Profiling Analytics puts at your fingertips the metrics and intelligence you need to improve your payer processes and the fiscal health of your organization.

Every day, hundreds of hospitals use MedeFinance’s intuitive dashboard and familiar “point and click” capabilities to answer questions like these:

• What are the most frequent causes for each payer’s denials?
• Which payers have the highest clean claim ratio? The lowest?
• What reimbursement patterns are common across payers? Unique to payers?
• What are our greatest opportunities for process improvement?
• How does payer performance vary by department, service, patient type, payer code, and other factors?
• What can I do to minimize payment variance?
• Can I match outgoing claim, eligibility, and status inquiries with incoming remittances and inquiry responses from payers?

Our exclusive Payer Profiling Analytics help healthcare financial managers and executives to:

Gain Control of Payer Adjudication

Identify your riskiest payers and your most reliable payers through payer profiling risk assessments using a variety of key performance metrics (payment ratio, reject ratio, denial ratio and others), so you can respond swiftly and appropriately. Spot internal process breakdowns by reason code and payer tactics. Measure and monitor frequently utilized rejections and remark codes. Improve clean claim ratio on outgoing claims through the use of historical intelligence. Gain deeper insight into non-reimbursable services by payer.

Systematically Shorten the Resolution Cycle of Claim Discrepancies

Measure adjudication turnaround time and speed up slow payers. Gain rapid insight into process leakage and understand root causes by functional area. Accelerate time- to-resolution by creating automated alerts for high-value or high-frequency rejections. Cut negotiation costs and leverage multi-claim follow-up with payers by “batching and submitting” same-reason rejects/denials. Create alerts to notify key staff when payer performance reaches undesirable levels; establish watch lists by claim type, accounts, payer codes, and others.

Increase Your Staff Efficiency With Actionable Root Cause Intelligence

Free up huge chunks of staff time just by eliminating silos of disparate data sources with a secure, centralized source of intelligence available 24x7. Empower all revenue cycle stakeholders with powerful root cause analysis. Securely share information across the enterprise with per-user access control. Perform receivable roll-ups with powerful data filters and pivot tables. Review receivables with your choice of easy-to-read reports and insightful graphs.

Software and Services Available On Demand

Because MedeFinance is a hosted service, it’s always on and instantly available. It’s virtually maintenance free, so your IT organization can focus on supporting your primary mission of patient care. Our Client Services staff is comprised of experts in health care financial performance, HIPAA, and all other relevant technological and regulatory requirements – all of which enables us to deliver very rapid time to value with very little risk.