Compliance Alerts
The Challenge of Compliance
Why are we always the last ones to know
that we have a compliance issue?
Is there a better way to manage performance guarantees and compliance?
Compliance Alerts in the Decision Desktop make it easy to track and
manage individual compliance and performance issues every day.
Many payers manage compliance retrospectively, checking reports after
compliance issues have become critical. Compliance Alerts make it possible
to proactively and in real time track critical service and compliance
metrics. If you are 'on the hook' to manage claims turnaround or aging or particular
denials, Compliance Alerts are tool to help you do that.
Compliance Made Simple
The Compliance Alerts in the Decision Desktop are a user driven
claims process alert tool. Early in the development of the Decision
Desktop we saw how time consuming and
difficult it was for plans to check and manage critical compliance related
measures. To simplify tracking compliance we developed Compliance Alerts
as an email based tool in which users themselves can define the metrics
and thresholds they need to track. Once they have set up their compliance rules
the Decision Desktop checks them each day/week/month and sends an email with an update.
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Track Performance Guarantees.
Tracking performance guarantees for employer groups is difficult -- and in
many cases not possible. This frustrates employer groups. The alerting tools
in the Decision Desktop makes it possible to track many critical claims process
metrics at the individual employer group level. These can then be reported to
employers (or not). The Decision Desktop makes it possible to manage employers
in a way they've always wanted to be managed.
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Track Compliance Metrics.
Compliance issues are inevitable -- they happen to every payer. Managing compliance however,
is not an option, the question is how best to do it? Compliance Alerts are designed to make
it easy to track critical service and payment metrics that are used by various State and
Federal organizations to track compliance.
Innovation, Flexibility, and Scalabilty
How do the Compliance Alerts work? They work by combining four core data technologies.
First it loads open and closed claims data each day and applies a set
of business rules to each claim. This enables the Decision Desktop to
uniformly and transparently report performance (Would you like to see the rule used to determine duplicate
claim lines?).
Second, it aggregates the claim data to enable reporting across periods.
Decision Desktop aggregations make it possible to see monthly, quarterly, and
yearly views of data for individual providers in seconds (Would you like to see the total volume of claims denied
in 2006 as a duplicate for that provider?).
Third, it loads the individual claim data into a search engine (claimfetch) that enables
users to search on indivual and sets of claims (Would you like to see 100 random claims
that were denied as duplicates for that provider?).
Fourth, the alert engine enables users to set alerts that track and email individual
performance changes (EDI rate drops from 85% to 60%) to users when requested.
These four technologies enable robost reporting, alerting, and root cause analysis.