Behind the Curtain: What to expect when you implement Pareo

Behind the Curtain: What to expect when you implement Pareo

Pareo is a unique platform that integrates with other software solutions to provide a comprehensive look at a health plan’s payment integrity processes. Here’s how we approach implementation of enterprise technology.

Just got word that your health plan is adopting Pareo® as a comprehensive payment integrity solution? Here, we pull back the curtain on what all goes into ensuring your health plan and Pareo work together in perfect harmony.

How We (All) Got Here

Our path to Pareo wasn’t all that different than yours. We started with a seemingly-unsolvable problem: How could we get a better view on everything we needed to see in order to effectively manage claims operations? With time, talent and industry expertise we developed a platform designed to transform payment integrity operations and shifted our focus to healthcare technology. 

We acknowledge that when you offer folks a solution they’ve never seen before, you have some educating to do. As such, here are some resources from our archives that touch on some of the steps leading to adoption and implementation of Pareo: 

Meet the Team

ClarisHealth has a team of experienced professionals dedicated to ensuring your Pareo implementation is a smooth transition. Leading the pre-Implementation team is Ric Stubblefield, Director of Implementations. Ric has overseen implementation of healthcare Software as a Service (SaaS) solutions like Pareo for nearly a decade, managing large teams of project managers and specialists while also serving as the main point of contact for clients during the process. 

At ClarisHealth, the Implementation team works closely with Product Support to guide clients through each stage of Implementation and ensure a seamless hand-off after the implementation project is complete. Our post-Implementation team lead is Yaw Agyemang, Director of Product Support. Yaw leads a team of product consultants who ensure that the functionality of Pareo meets the needs of our end users. He has decades of healthcare industry experience and has been a key contributor to shaping Pareo into the solution it is today. Yaw’s team serves as the ongoing point of contact for Pareo users. 

Why does this matter? As industry vets, we understand our clients and their frustrations because most of us have either been in your shoes or worked so closely to this industry that we know the long-running pain points you face. Under Ric and Yaw’s leadership, we’ve selected team members that are uniquely devoted to your success: 

    • Problem-solvers with a results-first focus
    • Industry experience
    • Clear communicators
    • Proven methodology with training every step of the way

Pareo Implementation in 7 Steps

Though we cater our implementation process to meet the needs of each individual client, our decades of experience have taught us to follow a seven-step process to guide each implementation project:

Project Kickoff

The Implementation team will review the statement of work (SOW) and develop a communication plan that establishes meeting and reporting cadences. At this stage, we will review the major components of each project and identify key deliverables. Known challenges are also acknowledged as our team prepares for discovery. 

Discovery

VP of Operations Kevin Jordan works closely with our Implementation teams in a discovery process that reviews workflows, user access (including role definition), reporting needs and process exceptions. During this phase, we also conduct a technical discovery. This includes the review of data file layouts, frequency of delivery and reviewing claim system integration requirements and file formats. This includes identifying vendor submission file formats.

Data Gathering

We conduct data gathering operations throughout the project. Initially, this phase consists of defining roles and rights for each user. Our team will also gather vendor details and load order, creating and reviewing sample reports. Data definitions are created as well as integration file formats. This is the stage when we begin communication with vendors and initiate training.

Configuration and Data Transfer

Configuration is dependant on the process workflows defined in the discovery phase, for both test and production environments. Clients can expect their reporting and dashboards to be created during this phase, configured and loaded into Pareo for review. As such, historical claim, provider and member data files are loaded and mapped. Custom fields are also tested and reviewed in this phase.

Testing

In the testing phase, we use sample vendor files and test all loading logic, review validation workflows and test claim system integration. Reports and dashboards, reviewed in the previous phase, are evaluated closely here for accuracy. Also, all user roles are security tested in this phase to ensure accurate access has been granted.

Client Sign-Off

In the test environment, once approved, the client signs off on the work that has been done. This triggers the creation of the production environment. Once the production environment is created, data migration occurs after which a final review is conducted before final sign-off in productions. 

Go-Live

The last leg of the process! During go-live, health plan and vendor production files are submitted into Pareo. Any issues found at this stage are actively managed by the Implementation team. Once resolved and when all parties agree that go-live is a success, the client is transitioned to the ClarisHealth customer success team! 

Average implementation projects last six to nine months, though this timeframe very much depends on a client’s needs and the SOW. As we implement Pareo at your organization, we have structured our process to include best practices allowing us to act in a secondary role as a software implementation consultant. This approach allows us to offer greater value to clients, who rely on us to lead them through this transition. 

This consultative mindset continues post-implementation. We have internal teams solely focused on developing education and other training tools and delivering those to clients in an ongoing manner to support engagement and utilization of Pareo. 

Talk to ClarisHealth about how Pareo® comprehensive payment integrity technology is helping health plans deliver on their most advanced digital strategies.

Managing Medical Record Requests a problem? We’ve got the solution.

Managing Medical Record Requests a problem? We’ve got the solution.

How to manage medical record retrieval processes with multiple clinical audit vendors.

Is your health plan missing out on the potential of having multiple clinical audit vendors because you’re concerned about overlapping medical record requests? That uncoordinated approach to medical records retrieval is unnecessary in the modern age of vendor coordination and provider communications. 

For health plans that are ready to maximize their returns, improve recoveries and avoid the abrasion created by redundant medical record retrieval processes, Pareo® is your answer. Pareo is a comprehensive payment integrity solution that works by making data more accessible, connecting it to multiple stakeholders and managing real-time communications (including those related to the claims process and associated with technology vendors). With these efficiencies in place, health plans are able to maximize their recoveries by adding clinical audit vendors. Data is no longer siloed — it can be seen, used and leveraged by health plans. That’s the power of Pareo. 

Overlapping Medical Record Requests Begone

Suppose your health plan were to prioritize adding clinical audit vendors without a broader management tool in place. One of the very real side effects of this practice is overlapping medical record requests. It’s frustrating for everyone, especially providers who seek to prioritize patient care over cumbersome administrative processes. 

In instances where health plans have a lot to lose (recoveries, valuable providers, plan members), clear communication is crucial to success. We understand that our clients need to do more than just talk at stakeholders; they need to intelligently coordinate with vendors, providers and members in a streamlined but meaningful way. 

Unfortunately, some of the payers we speak with feel forced into an impossible decision: improve provider relationships OR recoveries. This approach, while understandable, is unnecessary. What if you could do both? What if expanding recoveries through adding vendors — a smart strategy for scaling health plan payment integrity operations — wasn’t stressful on providers? 

Harmony: Vendor Coordination + Provider Communications

By eliminating the fear of overlapping medical record requests, you are free to stack the best vendors to your advantage. Directing vendors to laser focus on their area of expertise creates more potential for finding anomalies; for example, having vendors concentrate on a line of business (e.g. Medicare Advantage, Medicaid, commercial). Data tells us that any time a health plan adds a vendor in a multi-pass capacity, their ability to increase recoveries improves dramatically. 

But don’t leave providers out of the loop. Health plans often run a planned series of audits that parallel those that a provider performs. With Pareo, each party can be on the same page about these audits; knowledge and understanding of them beforehand can minimize redundancies, says Healthcare Finance.  But as we all know, it’s not as simple as straightforward communication between a payer and a provider. Vendors are an important component as they rely on data to deliver results. 

Enter Pareo Clinical.

Pareo Clinical: Eliminates Risk Around Medical Record Requests + Retrievals

Tackle risk, reduce inefficiencies, increase nurse auditor throughput, improve your net promoter score (NPS) and increase recoveries with Pareo Clinical. Our solution provides gates and custom logic that streamline the medical records retrieval process to coordinate with vendors, eliminate duplicate requests and auto-route submissions to the appropriate auditor with smart tagging so nothing gets overlooked. 

To enhance communication, our solution creates a unilateral or bi-lateral portal of communication for our clients that allows them to not only communicate with vendors but with another very valuable player: providers. We understand that in today’s IT ecosystem, a true solution has to “speak” with multiple stakeholders in a way that removes redundant, wasteful processes. 

Those communications streamline activities that can be automated. But perhaps just as important, Pareo allows for sophisticated coordination between all stakeholders. With our technology, even pending requests — days outstanding, notes on interactions, etc. — can be tracked to prompt proper follow-up strategies. These efficiencies mean more clinical audit vendors and less abrasion with providers. In today’s world where health plans are being asked to do more with less, a scalable, comprehensive solution is the strongest way forward. 

Learn more about how Pareo supports health plans, providers and third-party vendors

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans stride confidently into an uncertain future.

Should You Build Your Own Supplier Management Solution?

Should You Build Your Own Supplier Management Solution?

Take our quiz to help you decide if build or buy is right for your health plan. 

By now, you likely realize that your health plan needs a way to manage the many third-party vendors that allow you to maximize recoveries and optimize costs. The question is, should you build a solution internally or buy one?

We routinely run across health plan stakeholders in the midst of customizing their claims editor and other resource-intensive but relatively manageable IT projects. Most recently, we encountered a health plan considering building their own vendor management solution. That they need a solution is understandable. That they plan to build it themselves begs the question, “Are you a health insurance provider or a technology company?”

You know building your own software is going to cost more than you budgeted for, your IT resources are already constrained, and your expertise may be limited. But if your needs are truly unique, why look for a flexible, robust technology solution created with the support of industry-wide insight when you could devote millions of dollars to a solution of your very own?

In all seriousness, building a software solution with the ability to plug into dozens of independently-operated platforms (as in the case of third-party vendors) requires some heavy lifting. Are you ready? Let’s find out!

Should You Build or Buy a Vendor Management Solution? The Quiz

To take this quiz, view the following slideshow and record your answers. 

 

Results

 

Perhaps you’ve already tried to build your own IT solution, and it didn’t go anywhere. Or maybe you’re on the fence about building something that’s already on the market. However, you aren’t sure if what’s out there is really what you need. Not all vendor management solutions are the same, and we’ve learned that our clients appreciate the customization opportunities that Pareo® offers. In fact, we offer the ability for health insurance providers to completely outsource vendor management to us.

Because you’ve likely tried to build a software solution before, you may face internal pressure to just “make it work.” Here’s a helpful guide that discusses what it takes to successfully develop software (hint: It’s not simple). Borrow a page from tech company playbooks and take a realistic approach to any internal software development efforts.

You may – or may not – be able to successfully build your own vendor management solution. But it’s important to ask if IT development is really your true calling. Most health insurance providers we speak with develop internal software solutions as a means to an end. They quickly realize that the upkeep and maintenance associated with these insular solutions is not manageable. That’s because building an internal IT solution isn’t the same as buying one from a company whose sole focus is solving the types of challenges your health insurance company faces.

“Technology alone delivers no value. It’s the combination of a clear strategy, the right technology, high-quality data, appropriate skills, and lean processes that adds up to create value. Any weak link in this chain will lead to poor value delivery from IT,” writes McKinsey. As you evaluate whether or not to build or buy your own vendor management solution, consider all the elements at play. Technology alone isn’t enough; to be successful, you’ll need a force behind your internal IT development.

You are the healthcare insurance unicorn – an IT-heavy, resource-laden organization that really can build your own internal software. We would ask you though, why reinvent the wheel? If a great vendor management solution does exist, and can be customized, why not tackle a software development project for which there isn’t already an answer?

“Building custom software can unlock a host of benefits, but companies should only pursue that strategy if a) better software can provide a competitive advantage relative to your competitors, and b) you are building a large business that can spread the cost of a proprietary system over a large number of clients,” writes one Forbes contributor with experience on the matter.

Taking on a software development project like this may derail your small IT resources, who would be better focused on their core competencies. We suggest exploring solutions that are already built and extremely customizable, like Pareo®. Not only do we offer the technology you need to manage multiple third-party vendors, but we also walk small health insurance plans through the steps of payment integrity program creation. Still sound like a little more than you’re ready for? Consider completely outsourcing vendor management.

By outsourcing vendor management, you can quickly implement a successful payment integrity program that your IT department can plug into. Consider what qualifies as “good” when it comes to vendor management: “Good vendor management allows your organization to build a successful and stronger relationship with your suppliers or service providers.” Can you really do that if your time, attention and money are caught up in developing software to manage vendors?

Final Thoughts

In an age where customer-centric technology projects are increasingly consuming the insurance industry, building a supplier management solution yourself may just be a waste of time. We developed Pareo® to specifically address the concerns of this industry: Function, Flexibility, ROI.

In fact, it’s not uncommon for Pareo® clients to see a 10x return on their investment. Read our latest case study to learn more.

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Why we focus on the problem, not the health care solution

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Creating a Community of Users

Creating a Community of Users

When you adopt Pareo®, you gain access to a large community of health plan professionals offering shared expertise.

From time to time, we like to remind our readers that “you don’t have to go it alone.” That isn’t just an empty catchphrase we use to market to new clients. In fact, when you adopt Pareo® at your health plan you’re actually getting much more than an advanced payment integrity solution. You’re also gaining access to shared expertise. The industry terms this a “community of users,” and here’s why we think Pareo users especially benefit from ours.

Tech Comes to Life

Pareo is more than a “pile of code.” Numerous health plans — of all different sizes, with different lines of business, etc. — all working within a common platform is a feature of the SaaS model, not an accidental by-product. The ability to socialize with other users is the ultimate cherry-on-top for health tech solutions, according to Harvard Business Review. In an increasingly digital age, we value the ability of our payment integrity technology to come to life through a community of users.

But what is a user group, exactly? It’s a tiered-group comprised of users that form an association (the user group) hosted by the technology developer. These groups serve to aggregate knowledge and as others have pointed out “at its best, this model delivers constructive and purposeful relationships between and among all three players and remains symbiotic in nature.”

What’s more, when you find a payment integrity tech solution that has a community of users associated with it, you know it’s truly something special. As a self-described “user-group junkie” says: if a product is truly great, users want and benefit from a community (case in point: Apple). For those considering building their own payment integrity technology solution, the benefit of accessing a community of users alone may be big enough to compel them to buy into an existing platform instead.

Not a First Mover? Become a Fast Follower.

If you’ve ever been a part of a community of users (and chances are, if you’ve visited on online forum for a piece of technology, you have), you’ll notice some subsets within the group. Those that are early adopters to the technology may be the most vocal, offering input through whatever channels are available. We call this group “first movers.”

Being a first mover on exciting tech means that you often get to shape overall platform direction. As we’ve said before, some of our best ideas are born from our user ideas and expertise. Connecting with those early adopters of Pareo was an experience that continues to drive our passion for disrupting the industry. We learned early on from our users that our solution was unique.

Of course, we know not everyone can be a first mover. We term the second subset in a user group “fast followers.” Being a fast follower means that you get to benefit from the work first movers put in while still providing input as part of iterative software development. Our user groups today are a mix of first movers and fast followers, and we couldn’t be more grateful for their efforts to help us make Pareo even better. However, we aren’t the only one benefitting from the diverse group who leverage Pareo.

How You Benefit from a Community of Users

There are professional and personal benefits when you join a community of users. Because Pareo solves such a specific market niche, we think the shared expertise our users gain access to is unique to the market. It’s easy to see how a business benefits from uncovering solutions to industry problems, but there are other, softer benefits to be gleaned from being part of a community of users.

Professionally, employees engaging with a community of users are actively sharpening their problem solving skills while also networking with other industry professionals. This level of engagement grants you the opportunity to check you’re staying on the same page as other health plans. Payment integrity is such a focused skill set that networking opportunities are small, albeit mighty.

Still, sometimes these payment integrity efforts are so siloed at organizations that it can be difficult to connect with others facing the same problems. The more out of touch you feel with the industry, the greater the impact aggregated communal knowledge can have.

That’s why many believe the benefits of community extend to the workplace. But engaging with a user group isn’t just a professional box to check off. There are meaningful personal benefits to be had when you’re part of a community.

For example, we speak with some PI staff that find themselves burned out after trying and trying (and failing) to move the needle on recoveries. We find that they respond particularly well to the community of users within Pareo; they’re finally able to engage with those that not only understand their struggles but also appreciate their triumphs. That kind of energy may just be the invigorating force that helps you through the next work slump.

 

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans take advantage of collective insights from across the industry. Join our weekly demo:

Can your self-built technology solution do this? Why iterative software development is essential.

Can your self-built technology solution do this? Why iterative software development is essential.

Health plans considering self-developed payment integrity technology should ask themselves: Do we have the resources to be agile?

Iterative Software Development: A cyclical method of software development which focuses on improvements based on continual revisions and upgrades. User feedback is utilized to ensure that the software solution is successful.

In 2018, we released 33 updates to our payment integrity technology Pareo®, improvements that came directly from user feedback. Fast and flexible software development is essential in today’s digital market, which begs the question: can in-house developed software really be iterative?

It’s hard to imagine that a health plan is maximizing their resources by adding “software developer” to their byline. The more sophisticated elements of creating tech solutions — like iterative development models and Scrum processes — come by way of having the time, talent, and drive to focus on them.

Pareo® is especially attentive to user feedback, and it’s not just to make our clients feel “heard” (though that’s important, too!). We utilize the feedback that your team gives to proactively create solutions to problems before they fully surface.

Stages of Software Development

In order to effectively develop a solution to complex problems, software development follows a set process. This process consists of the following steps:

  1. Planning
  2. Designing Project Frameworks
  3. Development and Programming
  4. Testing
  5. Deployment

Software has a life cycle, termed SDLC (Software Development Life Cycle), that begins with planning and ends when a technology product is removed from the market. SDLC has many models, which include: Waterfall, Iterative, Spiral, Agile, and V-Shaped. Of these defined models, iterative is the most appropriate for large-scale development projects that need to remain flexible and responsive to varied conditions like regulations and multiple stakeholder requirements.

Iterative software development is an answer to the outdated processes that keep holding our industry back. In iterative models of SDLC, technology vendors are constantly improving aspects of their technology solution in a way that maximizes scalability but minimizes any total system downtime.

Why You Should Ask Third-Party Tech Vendors If They’re Iterative

Think understanding how software is developed and what model is utilized is too “in the weeds” for your health plan? On the contrary, these questions are essential to discovering how a tech vendor operates and how scalable a solution they are producing.

If the payment integrity technology vendor you are evaluating can’t speak to process and SDLC models, you can quickly rule them out. You’ll also be able to determine how quickly an update may come down the pipeline. Agile development produces constant updates, whereas traditional on-premise solutions are updated 1x-2x a year. Self-developed technology may never be updated.

Pareo® relies on an iterative development model because it works well in our industry. The flow of iterative development is circular, and works by repeatedly testing our technology solution to make sure it best serves its purpose. By soliciting user feedback and analyzing user behavior, we continue to work on solutions for clients that stay ahead of the curve. Additionally, this method of development allows us to consider what regulations and changes need to be incorporated into Pareo® to ensure it is functioning as a true agile solution.

How User Feedback Shapes Pareo®

When technology solutions don’t engage the end-user during development, what’s left is often an abandoned “solution” that’s left behind because it no longer meets the needs of the user. But as others have pointed out, you can’t simply ask a user if they like your product. Rather, you have to ask a series of strategic questions that solicit meaningful feedback.

When we partner with you, we partner with your associates.

The concept of a Net Promoter Score, or, learning how likely a client is to refer your product/services is extremely useful for software development. Asking additional probing questions such as “What problems do you encounter?” and “Are you satisfied with the level of customer support you receive?” are even better ways to solicit user feedback.

ClarisHealth not only captures this kind of data from our clients, but we also analyze how users engage with Pareo®. In particular, we like to look at which parts of Pareo® are utilized (and which are not). Sometimes, we learn new ways of utilizing Pareo® from user behavior! This two-pronged approach allows us to create a dynamic, fluid technology solution that users can effectively leverage in order to better do their jobs and improve efficiency.

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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Choosing a Payment Integrity Solution: the Ultimate Guide for Health Plans

Choosing a Payment Integrity Solution: the Ultimate Guide for Health Plans

Payment integrity solutions make many claims. Here are the top 11 areas of evaluation to ensure a perfect fit for your health plan.

The healthcare data deluge is coming. Is your health plan prepared to deal with it? Most of the health plans and payers we talk with are in one of two camps: a few self-developed solutions for claims audit and recovery, or scores of piecemeal applications used by the assorted departments dedicated to different areas of cost containment.

No matter your current approach, health plans have an increasing number of advanced technology choices in front of them – all promising “the answer.” As this article puts it: “New startups emerge every day, promising to hold the panacea for interoperability, data and analytics woes. As more players enter the game, it’s increasingly difficult to weed the snake oil peddlers from those who’ve got the right stuff.”

What’s at stake? Your rate of recovery.

Choosing the right payment integrity solution for your health plan holds arguably the greatest potential impact on your bottom line. When ClarisHealth conducted a survey examining payment integrity returns on claim spend at the leading national and regional health plans, we discovered a key difference. Those payers who had in place a scalable technology solution were tripling the rate of recovery over those who were struggling with outdated applications that require a great deal of manual intervention.

Virtually every health plan is looking to move their medical savings from a typical 1-2% today to something above 5% over the next few years. As your health plan looks at the emerging payment integrity solutions on the market, two questions will guide you in your search:

  • What are the most important elements to consider?
  • How do the different options – payment integrity solutions, self-developed technology, claims editors, FWA solutions, third-party services providers – stack up against each other?

In this post, we will examine the most important areas of consideration to offer a comprehensive payment integrity checklist for your health plan’s needs.

Get the Checklist

Click to download our Payment Integrity comparison tool.

Functionality is the Top Consideration

As you evaluate payment integrity options (and consequently, the tech companies and services providers that develop these solutions), functionality should be the top consideration. Nested under functionality are several areas of evaluation that make up a powerful payment integrity checklist:

1. Supplier Optimization

The ideal payment integrity solution should optimize the value you receive from third-party suppliers. Pareo® is the only commercially available solution that optimizes third-party vendor performance to help you realize, on average, a 30% increase in supplier efficiency. Functions like overlap control, contract management and performance reporting are all integrated through a single platform. Another benefit? Onboarding a new payment integrity supplier is quick and easy.

2. Audit Workflow and Analytics

Do you have the advanced analytics necessary to boost your own overpayment recovery efforts? Access the insights needed to create internalization strategies around cost optimization in both pre- and post-pay environments with confidence, and eliminate the routine administrative tasks that bog down your valued cost containment workforce. Fully customizable, streamlined workflows integrate vendor and internal recovery management efforts and boost internal analyst activity 3x. Pareo® provides the robust productivity and quality tracking you need to run and manage a large-scale internal audit workforce.

3. Clinical Workflow and Analytics

Who has the medical record? Concerns about increasing provider friction keep health plans from taking full advantage of the skilled clinical coders and nurse auditors on staff. What if you could coordinate seamlessly between your vendors and internal resources on provider outreach to prevent overlap while internalizing the best analytics from all sources and fully reconciling each audit?With Pareo®, clients average a 7% rate of recovery, relative to claim spend. Health plans can expand clinical and audit operations with advanced payment integrity technology, while decreasing medical expenditures by 2-4% and reducing the chance of errors.

4. FWA Case Management and Analytics

Fragmented case and allegation management tools that silo data unnecessarily stifle the effectiveness of SIU teams. Without real-time system visibility, health plans and managed care organizations can only hope to control FWA – not eliminate it. Broader access to this data could have tremendous value across the entirety of your health plan’s cost containment initiatives. Pareo® breaks down these data silos to create a comprehensive solution across all audit and investigation divisions of a plan while maximizing efficiencies with case tracking, investigations, and federal and state reporting.

5. Reporting and Business Intelligence

Drive your health plan to maximum effectiveness with actionable business intelligence. Pareo® provides access to real-time metrics that can be leveraged for accurate reporting when you need it most. Our system offers role-based dashboards, allowing health plans to scale business intelligence solutions system-wide.

6. Provider Engagement

Your payment integrity processes have the potential to damage or improve the payer-provider relationship. Features like electronic overpayment notifications, engagement tools, underpayment management and provider self-reporting can streamline your operations to improve provider relations and reduce costs for both parties.

If this functionality checklist covers more than what your health plan currently needs, that’s exactly the point. Your ideal advanced payment integrity technology should be scalable enough to grow as you grow. That doesn’t mean you have to take on all areas of functionality at once; a modular approach to implementation brings many benefits to health plans.

Additional Payment Integrity Evaluation Areas

A search for payment integrity technology doesn’t stop at functionality questions, particularly as a health plan evaluates various solutions and/or a more comprehensive platform. Some of the solutions that a health plan may evaluate as part of payment integrity program include: self-developed technology, claims editors, FWA solutions, and other vendors offering integrative technology.

After evaluating payment integrity vendors based on functionality, the following areas should also be reviewed:

1. Flexibility

Not all payment integrity solutions offer flexibility, which is why some health plans choose to build their own solution. That path, while offering full customization, also comes with some inherent problems. Read an analysis on the build vs. buy argument here.

2. Value Perks

Is the payment integrity solution in question able to identify and fill the gaps left open by current financial processes? How is ROI improved by this added value?

3. Integration and Ease of System Implementation

What training and support does the solution provider in question offer? How often do they update their platform, and how well will it integrate with current and future suppliers and providers?  

4. Data Accessibility

How important is SaaS vs. on-premise for your organization? Healthcare as a whole is increasingly moving all electronic systems to “the cloud” to increase stakeholder engagement, improve efficiencies and reduce capital investments in quickly-obsolete hardware.

5. Working with the Vendor

Whether your health plan decides to build its own solution, buy one or subscribe to one, you will be working with this group for years to come. How responsive, reliable and overall customer-oriented are they?

How Does Comprehensive Payment Integrity Stack Up Against Other Solutions?

When we speak with health plans and payers, we find that there’s some confusion surrounding the elements of a robust payment integrity program. In particular, a claims editing solution or a FWA tool  are sometimes seen as a complete payment integrity management tool, even though we regularly uncover gaps and hidden revenue for plans that rely on just a claims editor.  

We’ve said it before, and we’ll say it again: these modular solutions are not the same as a comprehensive PI solution. That isn’t to say they can’t work in tandem; for instance, Pareo® was created to integrate with third-party suppliers as well as optimize multiple supplier relationships for health plans. As we build this checklist, keep in mind that the benchmark is total payment integrity functionality. However, this payment integrity solution tool can be used to evaluate other elements of a payment integrity program.

Here’s how Pareo® compares to other payment integrity solutions:

  • Self-developed Technology: Self-built payment integrity solutions incur large, ongoing costs for health plans. Pareo® can be quickly implemented and offers many immediate benefits to a health plan, versus a self-built solution that will require a longer lead time before ROI is realized. Additional considerations for those considering building an in-house solution are: functions that need to be included, cost, time, and vendor integration.
  • Claims Editors: Pareo® works in tandem with claims editing solutions by improving the scope and automating much of the workflow.
  • FWA Solutions: FWA solutions, like claims editing solutions, are limited in scope and therefore not comprehensive. They should not be a health plan’s only line of defense in preventing improper payments.  
  • Third-party specialized suppliers: A health plan considering third-party vendors doesn’t have to choose between Pareo® and their business partners’ solutions. Pareo® offers supplier optimization tools that allow for platform integration, improving a payment integrity system’s performance and workflow.

 

Why should Pareo® be on your health plan’s list of payment integrity solutions to consider? Every week, we provide a no-hassle look at what Pareo® can do.