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Ancillary Benefits Management (ABM)

A Unique and Powerful Tool for Managing Ancillary Benefits

Unique to the industry, this groundbreaking Ancillary Benefit Management program provides clients with a centralized tool for managing the quality, costs and services of their contracted ancillary providers.

Managing the various providers and ancillary medical services involved with treating workers’ compensation claimants is frequently a complex and administratively intensive process for many insurance payers. Performing the large number of manual tasks, with the minimal amount of information available when making a referral or request for service, often results in a time consuming and unpredictable process for many claims professionals. These challenges hold true for managing various ancillary services like DME, transportation & translation, home health, electro-therapy, and many others. Other challenges are costly due to how vendors inconsistently price and deliver similar services while using non-descriptive HCPCS codes in the retrospective billing process. The end result is a service delivery model requiring more effort to administer and reconcile the overall program functions than managing the costs and quality of care.

The Healthesystems Ancillary Benefit Management (ABM) Program is a revolutionary new platform for managing and adjudicating ancillary medical services. Unique to the industry, this groundbreaking program provides clients with a centralized tool for managing the quality, costs and services of their contracted ancillary providers. This proprietary and automated program prospectively adjudicates all services (prior to being provided), resulting in greater savings and optimal utilization. In addition, it consolidates all referral, billing and payment processing onto a single platform, eliminating the complexities involved with managing multiple vendor relationships.
 
Preferred product guidelines can be established to assist claims professionals with selecting the most appropriate products when making a referral. A product coding structure — more descriptive than the commonly misused HCPCS codes — has been developed to identify product comparisons including detailed descriptions of all miscellaneous coded products. The process ensures appropriate pricing is applied for all products, resulting in accurate billing and eliminating retrospective bill disputes.
 
Using Healthesystems’ web based portal, Verticē, clients are able to perform real-time referral and authorization processes to minimize the need for phone calls and other manual tasks typically associated with ancillary services. This powerful tool communicates real-time information throughout the adjudication process and applies client defined rules to determine authorization workflow. Users also have access to consolidated reports of all vendor and program data including performance and trending summaries as well as claim level detail. Information can be exported to desktop applications including spreadsheets and PDF files.
 
The Healthesystems ABM program produces significant cost savings, achieved through a variety of means, including reduced unit cost, improved utilization management, and elimination of administrative overhead.

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