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Providing Solutions for Better Efficiencies
The operating environment today for Federal and State health programs is one of high claim volume, fast-changing rules and strict regulatory requirements. Though public, these programs still face the same challenges as their private counterparts – cost pressures, provider relations, compliance issues – and all in the face of public and political scrutiny.
In order to overcome these obstacles, Federal and State payers need vendors who are cost effective, open and flexible. In the past, claims editing vendors have been none of these things. Lack of choice led to high prices and poor service. As other public sector vendors, such as fiscal intermediaries, adapted their businesses to add more value, the editing market stagnated with overpriced, hard-to-install legacy systems that failed to keep current with coding standards. Extremely long implementation times for these systems meant edits were often outdated by the time they were installed. Worse yet, these inflexible systems did not accommodate state-by-state policy variations. A Better AlternativeFortunately for public sector payers there is now an alternative to poorly performing, overpriced editing systems. Bloodhound’s ClaimsGuard™ solution provides better editing results and service, seamless integration with MMIS systems and improved provider relations. How? Through a blend of cutting-edge ASP technology, world-class service and a comprehensive library of open-sourced edits.ClaimsGuard™’s flexibility allows it to easily integrate with any MMIS or transaction system. Because it is ASP-based, integration is fast and easy, and ongoing maintenance is Bloodhound’s responsibility, not our clients’. ClaimsGuard™ is built on a foundation of 100% open-sourced edits from CMS, AMA and other national standards organizations. This “white box” approach to editing is in stark contrast to the “black box” proprietary edits of competing vendors that can cause multiple provider relations problems. Since we continuously update the edits in our system, Bloodhound guarantees they will all be compliant and current with CMS guidelines. Customized Editing Across Every FieldThe difference between Bloodhound’s advanced technology and yesterday’s editing systems does not end with integration and open-sourced edits. It continues with the unique ability to customize editing on every claim field, and across every state/geographic or line of business, as opposed to the past limited option for public sector payers of turning on or off particular edits. Our system is configured to completely codify a payer’s specific reimbursement policies across all lines of business.This flexibility and customization is further supported by ongoing consulting services. Not only do our account teams get clients up and running, they serve as a continuous, accessible resource. We provide hands-on quarterly reviews and customized ad hoc reporting to give clients clearer insight into current business practices and a better understanding of the impact of their reimbursement policies. Additional support is just a phone call or email away. To further empower clients, Bloodhound provides online tools that let public sector payers' staff and providers view all edits and sources for each claim. Achieve the Results You NeedClaimsGuard™ achieves the results you need – and we can prove it. When run against the paid claims files of numerous public sector payers using other editing systems, ClaimsGuard™ consistently pinpointed overpayments. Let us show you how our sophisticated algorithms, duplicate logic and total patient histories track down inaccuracies that other systems cannot. The next time your editing contract comes up for renewal, don’t settle for what you already have! Demand open-sourced, up-to-date edits, flexibility, performance and fair pricing. When you do, you’ll discover what leading fiscal intermediaries, State Medicaid plans and Federal agencies already know: Bloodhound puts you on track to greater efficiency and higher savings. |
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