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Provider Contracting
eprovion supports the entire lifecycle of contract management - from preparing for a negotiation using provider profiles, to planning a negotiation calendar, to monitoring the contract during its lifetime and finally the renewal or termination of the contract. All of this is supported in one easy-to-use environment with powerful MS-Office integration. Contract templates can be created for reuse, and contracts can be annotated, versioned and batch-processed.
Benefits: A Health plan will benefit by streamlining the contracting workflow right from review and approval process to versioning, renewal and amendments of the contracts. The ability to tracking of negotiation is of immense benefit for executing the contracts effectively. There is strong scope of standardizing the contracting language by having templates to be used for various kinds of contracts. The templates can be effectively created by using the clauses, rate tables and attachments from a library. The templates thus can be used for multiple contracts of same nature. There is a better visibility of the contracts as they are stored in a centralized repository.
Provider Reimbursement
In eprovion there is support for various reimbursement methodologies for physicians, medical groups, hospitals and ancillaries. The methods for physicians include capitation and fee-for service models. For hospital contracting discounts, per-diems, DRG and APC based models are supported. Contracting is supported for networks,medical groups and ancillaries also.
Benefits: As the reimbursement model is comprehensively maintained for different set of providers as per the contracts, it is easy for the health plans to reimburse for the services to providers in a very classified manner. As there is proper visibility of the contracts with the providers, there is accuracy in the reimbursement to the providers thereby reducing the costs to a great extent.
Claims Integration
eprovion brings a new level of efficiency to claims processing by enabling accurate contract loading. There are tools for mapping contract clauses to claim system parameters, and for automating the loading of contracts into claims systems. eprovion's claims integration also enables the creation of provider profiles from claims data.
Benefits: Accurate contract loading into claim systems helps the health plan to pay the claims accurately. Mapping of contract clauses and the rate tables into claim systems parameters results in nullifying the over payment of claims and fraudulent claims. This is a very good advantage for the healthplan in terms of reducing manual claim processing. This whole feature helps the healthplan to reduce cost to a great deal.
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"You have taken care of contracting language and rates. Its great to
templates in the application. This is a great organizational tool." |
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Contract Manager,
Humana |
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