Enrollment GPS compares & reconciles member data with external monthly full file 834 against QNXT membership system. It compares the detailed eligibility data, rates, dual membership. GPS also compares outbound membership that is sent to Providers to match the incoming membership data and PCP selections. The errors are highlighted on simplified BI dashboard.
Ensure members can access service at point of service, especially on 1st of the month (Rx is most critical).
Automate Monthly Full File Compare
Improve FAME Monthly processing time from weeks to few hours
Compare 834 data element with Membership data
Identify Rate mismatch, Dual coverage mismatch and PCP differences
Identify Retro historical changes
Ensure all trading partners & providers receive the correct membership data
Gather & trend enrollment quality metrics
Identify and Fix errors in membership data
Ensure compliance and audit trail
Identify and Fix technical errors
HiPaaS Patient GPS Analytics
With Patient GPS:
Value of Patient is focused on financial profit/loss per patient and preventive care patient satisfaction levels. There is no better way for Clinics/Hospitals to calculate the value, cost & preventive care for clinics than guessing and going thru multiple spreadsheets. Normally, clinics realize the amount of loss after the fact – in few months/quarters.
HiPaaS GPS takes into consideration various factors like CPT Cost, Inventory cost, real estate cost, Practitioner cost, Referral commission, Marketing , admin cost and other ongoing cost – including charge backs. Intangible value of Preventive Care is determined based on various treatment factors: HiPaaS GPS takes into consideration factors like number of visits, number of procedures, repeat procedure treatments, pharmacy prescriptions, quality of treatment and overall duration of single encounter with Patient, Patient satisfaction and others.
The value is further categorized by value of patient, value by Procedure, value by insurance , value by agents/referrals, value by pharmacy, value by provider, value by commissions.
HiPaaS Claims GPS Analytics
With HiPaaS Claims GPS:
HiPaaS Claims GPS provides clear end-to-end view of Claims lifecycle. Every Claims 837 file, Paper claims are tracked, compared against EDI, QNXT, Facets. Claims statuses are tracked to provide intake and monthly view. Examiner productivity is tracked. Claim Payments are tracked.
Improve Claims reconciliation process
Account for every claim and file received. No Claims left behind!
Ensure proper access before approving claims
Submit Medi-Cal, Medicaid, Medicare Encounter data report
Account for every Claim and Encounter received
Increase auto adjudication
Identify delays in claims Adjudication
Identify Claims errors and fix them upfront – pre-processing
Hold Claims with specific scenarios
Identify and fix repeating claims Pend Scenarios
Ensure payment accuracy by matching it to 835 and ERA data
Measure Examiner productivity
All Data you need for Preventive Care
HiPaaS CFO GPS Analytics
With CFO GPS
HiPaaS Financial GPS compares 820 files with membership data in QNXT, Provider Network Payments, PCP changes and outbound 834 payments.
Get CFO Dashboard to account for every $
Compare 820 against membership and provider data
Compare 835 ERA against claims data
Ensure Providers are paid accurately
What are customers saying about HiPaaS?
The HiPaaS solution was easily implemented and has been a triumph for integration. It is everything we knew put in one place that facilitates deep dive analysis in a more efficient way. This has helped SFHP to reduce the time to market and increased customer satisfaction.
– Sunny C, SFHP CIO
HiPaaS API & EDI
API were simple to integrate. DevCool HiPaaS did a GREAT job helping the team gain confidence in X12, so that was HUGELY helpful! We’re confident that you’re more knowledgeable (with real-world X12 practical knowledge)
– Bob H, W Health plan Architect
HiPaaS helped us to integrate multiple Clinics using different EHR systems via HL7 in less time and low cost! With HiPaaS – we’re able to reduce our manual work for processing claims and can add more customers
– Peter K, Hippocratics CEO
DevCool Inc. launched HiPaaS in Q1, 2016 to address interoperability and data analytics issues within the Healthcare industry. HiPaaS is trademark of DevCool Inc.
DevCool is a trusted IT solutions provider and systems integrator to major healthcare payers and providers. The team has extensive experience in the healthcare industry and regulations.
About the Team
DevCool is developed by core team of experts in HealthCare, Technology and Systems Integration.