Hospital System
Organizations.
Capability 1
Our CALIBRATE family of contract integrity solutions apply not only to physician groups but also to outpatient facilities and DRG codes where the price per episode of care is high. We provide our healthcare system clients with the same payer claims repricing system as their payers on DRG weighting reimbursement, charges master validation, and coding reimbursement.
Capability 2
aCALIBRATE™ shows our healthcare systems where their DRG claims are reduced by the payer due to the payer’s code set algorithms and reimbursement. aCALIBRATE™ is used not only to understand, assess, and validate the integrity of contract allowables but also used as a DRG coding and compliance tool with our national code set solution.
Capability 3
ONECARECOST™ is the only solution whereby our clients can generate an Explanation of Benefits at, or before the episode of care whereby the actual claim is priced according to your particular contract and insurance product versus an estimate. Our clients know the payer allowable before the payer receives the claim.
Hospital and Health Systems
+ REVELOHEALTH™.
REVELOHEALTH solutions serve as the single information source between managed care contract integrity and revenue cycle management operations for facilities and physician practices.
REVELOHEALTH layers in Payer expertise with Revenue Cycle Management expertise to combine and make sure there is a match between expectation of payments and actual payments of claims.
REVELOHEALTH provides an end-to-end solution to equip Hospital and Health Systems with the intel, visibility and resources into the payer contracts to know exactly what you should be paid at time of service and maintain throughout the Revenue Cycle.
Benefits.
Contract Inventory: Our CALIBRATE™ family of solution inventories all your managed care contracts that you and your payers understand in real dollars, not simple averages.
Reduce the Cost of Collection: iCALIBRATE™ differentiates between a contract integrity variance versus an underpayment, reducing, and sharpening your claim appeal process and costs.
Transparency and NSA: ONECARECOST™ generates a customized and branded AEOP (Advanced Estimation of Price) at or before the time of service from your managed care contracted rate, not an estimate of the price.
Coding and Reimbursement: iCALIBRATE™ not only provides contract and pricing integrity but also used at claim production to understand DRG weighting impact with our national code sets used by our payer clients.
Contract & Payment Integrity: Establish each facility code, CPT code, and DRG codes prices by your contract rate and compare to the payer allowable to determine variances within your contract. Determine whether your payers are paying according to your contract at the time of payment posting.
Payer Contract and Provider RCM: Our proprietary solutions bring together the intersection of managed care contract price integrity and provider revenue cycle management in real time. No estimates or averages and real dollars, actual price, contract, and payment integrity.