New Solutions Validate Eligibility Data with Speed, Efficiency and Minimal Impact
ITASCA, IL (September 17, 2013) – Discovery Health Partners today announced that it has expanded its Intelligent Cost Containment solutions portfolio with new Eligibility Solutions that enable faster, simpler collection and sharing of eligibility data among payers, providers and employers. These Eligibility Solutions focus on the collection, maintenance, and integrity of eligibility data through data validation, record update and membership surveys.
“The process for capturing and storing eligibility data is extremely complex. Not only is it difficult to gather eligibility data consistently across all membership, but also maintaining accurate records is challenging because the data constantly changes,” said Paul Vosters, President and Chief Operating Officer, Discovery Health Partners. “Our Eligibility Solutions help customers to manage eligibility data more strategically. We create a single, trusted source of eligibility data that can feed critical claims decisions and cost containment initiatives.”
Discovery Health Partners’ Eligibility Solutions include the following:
- Eligibility Assessment, an in-depth analysis based on current eligibility processes and dependencies that maps out best practices, tools, and processes needed for higher levels of efficiency and quantifiable results.
- Eligibility Integrity, which helps clients avoid incorrect claims payments by analyzing all sources of eligibility data to identify inaccuracies, make updates, and maintain eligibility data correctly.
- Medicare Secondary Payer (MSP) Validation and Premium Restoration, which actively validates MSP records, correct inaccurate records, and restore premium dollars that have been underpaid due to record inaccuracies.
- Medicaid State File Validation, which confirms the validity of other coverage information collected by the state through its mandatory reporting.
- Section 111 Mandatory Reporting, which enables group health plans to comply with CMS mandatory reporting requirements while harnessing the power of eligibility data that is exchanged to pay claims correctly at first billing.
- Employer Group Reporting, which helps healthcare payers provide insight and transparency to employers so they can identify trends, evaluate participation, design and improve employee health plans, and compare performance against other employers in the same plan.
- Survey, which enables health plans to connect with their membership using various response channels to get needed information to improve process, avoid costs, and preserve program integrity.
The new Eligibility Solutions are managed by seasoned U.S.-based staff members with expertise in eligibility, healthcare law and data management and understand the disparate nature of eligibility data collection and maintenance in healthcare organizations. Coupled with this hands-on knowledge, Discovery Health Partners’ proprietary Intelligent Cost Containment Platform provides tools and applications for process management, data integration, reporting, and analytics to help automate workflow and integrate eligibility data across multiple systems.
“We build a foundation for a more efficient claims process, improved employer group reporting, and more accurate Medicare and Medicaid compliance and reporting,” said Vosters. “With health payers facing mounting pressure to manage cost, streamline processes, improve quality, enable compliance, and also improve employer satisfaction and retention, our Eligibility Services align with our entire suite of payment integrity solutions to deliver measureable results against these priorities.”