Today McKesson Health Solutions unveiled ClaimsXten™ Policy Management, an exciting new clinical and payment management solution that helps payers cut costs and improve “first pass” payment accuracy by streamlining and automating advanced policy rules and clinically sourced edits.
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ClaimsXten’s Policy Management Module (“PMM”) is a single-rule framework that can be layered into a multitude of policies, providing an enterprise foundation for streamlining the creation, deployment and maintenance of a wide variety of policies and edits. Payers can use PMM to address edits as early as possible in the adjudication cycle, and they can enable advanced policy designs—not just medical policies—including compliance and payment policies, special investigation requirements, and more.
“Payers are struggling to manage the pace and breadth of industry change, because their disconnected legacy systems aren’t up to the task,” says Amy Larsson, RN, BSN, MBA, Vice President of Clinical Claims Management for McKesson Health Solutions. “Payers need to ensure accurate payment for a wide variety of relationships with their provider networks, and they want to pay providers quickly according to their policy. With ClaimsXten’s PMM, we’re making it easier for health plans to compete with speed and agility in a market that’s becoming more complex and competitive every day.”
As the industry transforms to value-based reimbursement (VBR), health plans are under tremendous pressure to innovate faster, comply with new regulations quickly, and ensure accurate payment to providers. In just two years, payers expect 47% of providers to be in value-based payment arrangements, rising to 60% in five years.1
But as payers try to scale VBR, they are finding existing systems aren’t nimble enough to keep up with this intense pace of change. ClaimsXten’s PMM facilitates the move to VBR by helping health plans swiftly respond to market and regulatory changes. Complex policy changes that used to take four to six months to implement can now be created, deployed, and updated in just weeks.
Finally, health plans can respond with the dexterity needed to compete in today’s dynamic healthcare marketplace, while lowering administrative overhead and medical costs. Most important, ClaimsXten’s PMM helps promote fast, accurate payment on the “first pass,” dramatically reducing the potential for retrospective recovery, third-party audits, and appeals—not to mention helping foster more collaborative relationships with providers.
ClaimsXten’s PMM is available now. For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, Follow us on Twitter, Like us on Facebook, and network with us on LinkedIn.
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McKesson Corporation, currently ranked 5th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies, and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit www.mckesson.com.
Tags: McKesson, McKesson Health Solutions, ClaimsXten, ClaimsXten Select, Policy Management, Advanced Policy, Auto-Adjudication, Claims Editing, Claim Check
1 Journey to Value: The State of Value-Based Reimbursement in 2016, a national research study on healthcare’s transition from volume to value, conducted by ORC International, commissioned by McKesson (http://www.MHSvbrstudy.com).
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Last updated on: 17/10/2016
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