Inventory Payer contracts to establish Payer Rate Sheets.
CALIBRATE equips Providers with Payer rate sheets created and customized to the Provider/ Payer Contracts.
Price must match from the Payer rate sheets and Provider/ Payer Contracts in order to have accountable allowables to move forward.
Every evaluation is stacked up to site specific Medicare Index.
“a” represents the ASSESSMENT of your managed care contracts. Our process involves inventorying, assessing, valuing, and indexing your managed care contracts to your site-specific Medicare rates based on CPT codes and applicable modifiers. We remove the averages and modifications used by payers to adjust the allowables, which can make pricing transparency and net patient revenue uncertain or approximate under your managed care contracts. With aCALIBRATE™, you can see the price for each code under the current contract for every payer.
“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 takes mid-levels and anesthesia into consideration.
“i” represents the real time INTEGRITY of your managed care contracts. After your contracts have been loaded into our payer repricing system, we can reprice your current volume of claims in real-time. When we receive the standard 835 payer payment files, we compare each payer's allowable against your contracted allowable to determine whether there is a match to our contract. If a match is found, then the contract remains intact, and you can proceed with traditional revenue cycle operations. However, if there is any discrepancy, it indicates a change in the contract, or an error made by the payer. Our system identifies and reports all variances to your payer representative, categorizing them by CPT code and providing the reason for the variance.
Contract Integrity: The payer and provider reduce the collective cost of collection as both parties have the same pricing information on the same technology platform.
No Estimating: No translation between payer claim repricing systems and revenue cycle contract load systems or payment estimators are needed.
Price Transparency: By deploying CALBIRATE MODELER and CALIBRATE INTEGRITY to your managed care and revenue cycle processes, you know any change in the payer behavior in real time as the you have the price in our system before the payer receives the claim.
Clear Price Negotiations: Puts direct visibility into the payer technology and payer analysts on your team to assist in the negotiation process so you know the allowable for every episode of care for the contract. There are no surprises, estimates or averages.
360-Degree View: Full phase process of contract collection, inventory, and integrity to manage and monitor performance of Payer contracts.
Reduce cost of collection: CALIBRATE enables full visibility and drill down to CPT or DRG codes to mitigate changes to Payer contracts creating challenges in accurate reimbursement.
Same Technology: CALIBRATE is the same technology platform and process used by over 700 plans to price claims for their members.