Provider Abrasion Creates Poor Member ExperienceCommercial health plan customer satisfaction rates have remained stable in the last years, but emerging consumer demands hold the key to growth. In particular, health plan members are struggling to understand the administrative processes that make their plan work (according to the JD Power 2018 Commercial Member Health Plan Study). And as I’ve already illustrated, it’s very often the case that a provider’s own abrasion with a health plan means that the consumer directly deals with claims process inefficiencies themselves. We speak frequently on the negative consequences of siloed data, and how Pareo® answers this issue by connecting a health plan’s entire ecosystem, creating transparency to benefit staff members. But what if we told you that total visibility benefits your plan’s members, too? All by improving or preventing provider abrasion, which creates poor member experiences for health plans.
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Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.
The SolutionPareo is a Total Payment Integrity™ platform, aimed at transforming a health plan’s claims recovery processes. But housed within Pareo are modules that seek to improve or prevent provider abrasion. And since we’ve established that it’s important to health plans to keep members happy, and that members are decidedly unhappy when they have to deal with the administrative consequences of provider abrasion, we think it’s important to look at how Pareo can help. Pareo offers three core benefits that prevent or reduce provider abrasion: Vendor Overlap Management, Smart Work Queues, and Medical Record Image Capture and Storage. Let’s address each one:
Vendor Overlap Management
Our vendor management module allows a health plan to maximize recoveries and optimize costs, and it contains a feature we call overlap control. This feature eliminates unnecessary audits automatically. It prevents audits that are outside of vendor contractual requirements and if over-payment already exists, then it is prevented from loading into the audit review system. By streamlining vendors, your health plan will clean up any audit processes that are redundant or unnecessary on providers.
Smart Work Queues
Each payer has a unique audit and validation process, so Pareo customizes the entire lifecycle of an audit. Our streamlined workflows, which we call Smart Work Queues, increase analyst production by 3x. This smarter approach for health plans mean that data silos are shattered, and that providers (and members) will benefit from improved administrative processes that are intuitive and helpful (instead of redundant and frustrating).
Medical Record Image Capture and Storage
Process inefficiency is eliminated with Pareo’s payment error prevention program (PEPP). Digitizing medical records and storing them for our clients expedites otherwise slow processes. And, this module includes a drag-and-drop feature so that medical records are stored with a claim, making it much easier for them to access good data. With Pareo, medical records are easily shared between internal teams, allowing claim questions to be answered quickly