Advanced Technology for Today’s Editing Needs
In the past, editing programs were installed within a health plan’s claims transaction system. This business model resulted in costly implementations, thousands of dollars in “hidden” upgrade costs, and edits that were quickly out of date with each new coding release. Edits were also proprietary to the system vendor, making them unaccountable to national standards, as well as the source of much frustration for providers.
Improve Provider Relations
Enter today’s Bloodhound ClaimsGuard™ solution, providing better editing results and service with no client maintenance required, with the added benefit of improved provider relations. ClaimsGuard™ achieves all this through a blend of cutting-edge ASP technology, world-class service and a comprehensive library of open-sourced edits.
ClaimsGuard’s™ flexibility enables it to integrate anywhere in the claims stream, and with any transaction system or interface. Because it is an ASP-based service, 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.
Customized Editing Across Every Field
The 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 of turning on or off particular edits. Our system is configured to completely codify a health plan’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 health plan staff and providers view all edits and sources for each claim.
Achieve Proven Results
ClaimsGuard™ achieves the results you need – and we can prove it. When run against the paid claims files of plans using other editing systems, ClaimsGuard™ consistently pinpoints overpayments. Let us show you how our sophisticated algorithms, duplicate logic and total patient histories track down inaccuracies that other systems cannot.
