Claims & Contract Management

There has been a lot of uncertainty with regards to what the future holds for healthcare in the U.S., but the reality is that the move away from transaction-based services where providers are paid by transaction or by interaction with their patients, into a world where some of those services will be paid as bundles, is a reality. At Experian Health, our perspective is that there isn’t going to be one single form of payment. There isn’t going to be only fee for transaction or only fee for value type payments.  There is going to be a variety.  And our solutions can help providers handle that. When we talk to our largest providers, they want to make sure that they are prepared for the future of healthcare, and that their payment and revenue cycle is robust enough that they can handle whether it is a fee for transaction interaction with the provider or with the patient as well as fee for value. In order to do that, they have to optimize their operations. There is a lot of belt tightening happening in the industry and people are trying to see and understand how best to organize, how best to analyze and facilitate that payment cycle. We believe that data and analytics are two of the key ways to do that. Our software tools as well as the data that we embed into that software helps optimize the revenue cycle. Listen to the complete podcast

On April 27, millions of workplaces, employees, parents and children will celebrate the 24th year anniversary of the Take Our Daughters And Sons To Work® Day program, which encourages girls and boys across the country to dream without gender limitations and to think imaginatively about their family, work and community lives. This national, public education program connects what children learn at school with the actual working world. Experian Health's offices will be participating in this program as part of its Women in Leadership initiative. Learn more about it and how your organization can participate.

In case you missed them, below are links to recently created videos of our clients and staff, as well as links to recorded webinars. New Videos Our healthcare provider clients share their experiences and best practices using Experian Health’s solutions. Watch Now Chris Lah from Cincinnati Children’s Hospital shares his insight around healthcare reimbursement challenges. Watch Now Rachel Papka from Steinberg Diagnostic Medical Imaging Centers outlines her orders management challenges and how her organization has overcome them. Watch Now Karly Rowe from Experian Health highlights the importance of matching, managing and protecting patient identities to safeguard medical information and reduce risk. Watch Now Tony Murdoch from Experian Data Quality explains how Experian's Data Quality Solutions can add value to our clients. Watch Now On Demand Webinars Patient Identification – The Challenges Healthcare Leaders and the Industry are Facing Today (HealthLeaders-hosted event). View Now (registration required) The Importance of Managing and Protecting Patient Identities (NAHAM-hosted event). View Now (registration required)  

In its first year of consideration, Experian Health’s ClaimSource® solution garnered the 2017 Category Leader title for claims management. This was achieved by having products and customer support that address the top issues in Patient Accounting, including: Declining reimbursement making it more important to ensure accurate payments Slow payment from third-party payers Having to make analytics-based key financial and operational decisions Constantly changing governmental mandates and payer requirements Managing the move from fee-for-service reimbursement to value-based reimbursement The challenge of finding skilled resources The continual stress to do more with less The Experian Health ClaimSource product suite addresses these challenges first by providing excellent products that are all seamlessly interfaced and can provide exception-based processing for: Automation of processing clean claims through the use of an expansive library of national payer edits The ability and willingness to create provider specific custom edits Expediting the follow up process thru the use of enhanced claims status detailed responses Enabling more efficient processing of denials by analyzing denials reasons and automating workflow Automating the payment posting process with customized posting files for handling splits and contractual adjustments Providing the best interfaces available for Epic clients for both hospital and physician billing offices We follow that up by offering superior customer support for our clients. By leveraging our size, experience, and multiple locations in Sacramento, California and our new location in Schaumburg, Illinois, we support clients from Hawaii to New York to Alaska to Florida and everywhere in-between. These two offices allow our clients to get great hands on support for implementations, training, extensive custom programming, as well as experienced billing analysts with decades of billing knowledge. We always thought our claims products stood out against our competition, but now KLAS has validated that for us. Ask your Experian Health account representative or email us at experianhealth@experian.com to find out how we can help your business office address your specific needs.

Experian Health and NCPDP (National Council for Prescription Drug Programs) have joined forces to introduce a vendor-neutral solution that powers a national patient identifier. Experian Health and NCPDP have announced a strategic alliance to provide a vendor neutral solution to address the complexities of managing patient identification. With a shared vision to create solutions and leverage data for the common good, this alliance brings an innovative matching solution that provides the framework for establishing a unique patient identifier to address patient safety, financial and operational challenges across the U.S. healthcare ecosystem. Read the press release here.

Below is a collection of some of most compelling article we've read in recent months. We hope you find these interesting, too! One Goal; One Contract: How a Nationwide Health Data Sharing Framework is Revolutionizing Interoperability https://www.himss.org/news/one-goal-one-contract-how-nationwide-health-data-sharing-framework-revolutionizing-interoperability   7 things to know about Aetna's ACA exchange exit https://www.beckershospitalreview.com/payer-issues/7-things-to-know-about-aetna-s-aca-exchange-exit.html   5 steps to cybersecurity for Internet of Things medical devices https://www.healthcareitnews.com/news/5-steps-cybersecurity-internet-things-medical-devices    CMS: ICD-10 specificity kicks in Oct. 1, 2016 https://www.healthcareitnews.com/news/cms-icd-10-specificity-kicks-oct-1-2016   3 leadership skills crucial for a culture change http://www.beckershospitalreview.com/hospital-management-administration/3-leadership-skills-crucial-for-a-culture-change.html

Scott Lee oversees the Experian Health Reference Program. Scott graduated with a BA in Business Management from The University of Texas at San Antonio, and has been with the organization for 12 years, beginning with MPV, which was acquired by Experian in 2011. Scott lives in San Antonio with his wife and two children and says his second home is the San Antonio Zoo based on how much time he and his family spend there. Scott is a catalyst for fostering the connection between Experian Health’s current and potential clients to allow the former to share their positive experience and ROI using our solutions. Our clients also benefit from being a reference by learning about the workflow and best practices of similar organizations. Because of the importance of protecting our clients’ privacy, Scott schedules calls on behalf of our clients and ensures that the experience is mutually beneficial and minimally disruptive for all parties involved. “We’re very appreciative of our reference clients, and it’s a privilege for our potential clients to hear their experiences firsthand.” he said. Share your story by being an Experian Health Reference Client! Contact your Sales Director/Account Manager or contact Scott Lee at scott.lee@experian.com or (210) 582-6320.

Below is an update from the Experian Health  Support Team. Network & System Performance Last six months: Upgrades to the network, compute and storage infrastructure have improved performance and scalability. Enhanced alerting and reporting to strengthen proactive measures for issues remediation Next six months: Data Center move and consolidation will localize production communications to improve efficiencies Automation improvements to reduce on-boarding times for new clients Subscribe to Receive Product Support Updates Opt in to receive emails about significant product updates or changes. Access the Experian Health Product Dashboard here.    

In case you missed them, below are some great tools to help you address key business challenges. Enjoy the read! Press Releases Innovative Mindset Enables Experian Health to Deliver New Capabilities Experian Health Rises to 45 On The 2016 Healthcare Informatics 100 List   White Paper Why Start the Payment Process Prior to Service? As a patient’s financial obligation grows, it’s imperative to tailor payment strategies to each unique situation. In pre-service stages, data-driven solutions provide a higher likelihood of securing patient payment. Flexible patient payment plans contribute to a positive billing, payment, and overall engagement experience, as well as a provider’s financial health. Read our white paper to learn more about the importance of the Personalization in the Healthcare Consumer Payment Process. Read Now   Article: Healthcare IT Transformation - How Has Ransomware Shifted the Landscape of Healthcare Data Security? Read Now