FAMILY OF SOLUTIONS. Inventory, assess, index, value and manage the integrity of your managed care contracts in real time using a payer claims repricing technology. This is not an estimate of a claim payment. We analyze each episode of care as a payer does using your managed care contract, with our payer claim repricing technology analysis'.
Create an Advanced Explanation of Price (“AEOP”) on or before the point of care to solve price transparency requirements, improve point of care collections, and identify net patient revenues before the payer receives the claim.
A new customized solution set for your revenue cycle operations using our payer claims repricing solutions as the foundation to reduce your cost of collection, improve your collection yield and maintain your managed care contract integrity.
A real time, customizable data mart of information at the intersection of your managed care contract performance, monitored payer behavior, and revenue cycle operation. Utilization of payer re-pricing technology to analyze payer behavior allows iSTACK™ to serve as the accurate and all-inclusive monitoring and reporting solution.
aCALIBRATE™ “a” represents the ASSESSMENT of your managed care contracts. We inventory, assess, value, and index your managed care contracts to your site-specific Medicare rates by CPT codes with all appropriate modifiers., DRG codes and facilities codes. We eliminate the averages and identify changes used by payers to alter the allowable that make pricing transparency and net patient revenue a "guess" or "estimate" under your managed care contracts. aCALIBRATE™ shows you the price for each code under the active contract for each payer.
mCALIBRATE™ “m” represents the active MODEL of your managed care contracts. We serve as your analyst on your managed care team in contract negotiations with a payer. We load each round of proposed rates and contracts into our payer system and generate a specific CPT code allowable with modifiers that even take mid-levels and anesthesia into consideration. mCALIBRATE™ gives you a payer technology and payer analysts on your team in the negotiation process so you know the allowable for every episode of care for the contract. There are no surprises, estimates, or averages.
iCALIBRATE™ “i” represents the real-time INTEGRITY of managed care contract. Once your contracts have been loaded and analyzed within our payer repricing system, we can identify the current re-priced claims in real-time. Upon receipt of your 835 standard payment files, we compare the allowable from each payer against your contract to determine a match. If allowables match, then the contract integrity is intact, and traditional revenue cycle operations can commence. If there is any variance, then there is a change in the contract that has occurred, or the payer has made an error. All variances are identified and submitted to your payer representative by CPT code. These variances do not go through your traditional revenue cycle claims appeal process. No claim appeal activities occur until the contract integrity match is completed.