We understand that healthcare payers need control over their payment integrity operations to best serve their members. Platform Access challenges the status quo of claims payment operations by empowering payers with transparency into their own data and the ability to orchestrate their business in a way that makes sense. Our prospective payment integrity solution empowers payers with content and technology designed specifically to address administrative waste and the root cause of payment issues.

Features

Complete Editing Library With History

Enable reimbursement, clinical and coding edits with access to history, parameters and exceptions

Custom Edit Builder

Turn specific policies into cost-saving edits

Embedded Analytics Suite

Provides a real-time view into performance metrics and the value HealthEdge Source™ is providing

Monitor Mode

Production-level modeling provides prospective insight into the impact an edit will have

Advanced Audit Trail

Provides a single place to track and view claim-level edit details

Cloud-Hosted

Delivering content and infrastructure updates automatically once every two weeks

Payment Integrity Health Check

Gain a deep understanding of problem areas and get the most out of your IP and our library offerings

Seamlessly Access Third-Party Content

Best-of-breed third-party content libraries natively integrated into the solution