Transparency
Visibility to End the Payer vs. Provider World
The relationship between healthcare payers and providers is portrayed and often is a strained one. The tension between cost and care plays out in many scenarios. Payers are under pressure to control costs, but the traditional lack of transparency in the adjudication process greatly added to the mistrust among providers.
So, are we doomed to a payer versus provider battle where the choice is between denying legitimate reimbursement or overpaying claims? With Bloodhound, the answer is no.
Rather than view the market as Us vs. Them or Payer vs. Provider, we have long embraced and advocated transparency and openness. In 2002, we were the first vendor to advocate open sources for all edits, replacing the then dominant black box proprietary model of industry. That is, 100% of Bloodhound edits come from open sources from standards organizations like the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).
Common Ground for Payers & Providers
Setting the Standard for Provider Relations and Transparency
- 100% open source edits from organizations like CMS and the AMA
- A full audit trail visible to payers and providers to see detailed edit messages and source documentation and all the claims involved in the edit
- Optional services which allow providers to correct miscoded claims for resubmission
Everyone Wins
Payers benefit from improving provider relations and reducing time spent on claims inquiries and appeals all while containing costs. Providers get full visibility, the knowledge that reimbursement is based on established standards, and faster claims settlement in situations where self-correction is enabled.