A Single Point of Connection
Our centralized platform for managing all ancillary vendors, Verticē, allows claims professionals to perform real-time referrals and authorizations.
A Simplified Solution
We removed the complexities from a cumbersome system. We replaced it with a fully managed transparent solution with customized workflows. We automated everything from referrals and prior authorizations to billing and payments. Gone are the manual tasks, endless calls, emails and bill disputes. In its place is an efficient system that:
- Optimizes utilization
- Reduces spending
- Provides detailed, accurate bills
- Measures vendor performance
- Frees up claims professionals to focus on high risk claims
Our focus on medically appropriate, quality care sets our ABM program apart. The involvement of our Clinical Services staff in our ABM solution provides payers with an added measure of confidence that physical medicine, home health, and additional services are being managed in accordance with evidence-based medical guidelines.
Our proprietary detailed coding structure eliminates guesswork. We assign unique codes and descriptions to every product – more descriptive than the commonly misused HCPCS codes. Payers no longer struggle with mysterious miscellaneous codes. They know exactly what product or service a claimant will receive and how much it will cost before they are delivered and the bill arrives. That’s the power of prospective adjudication in real time.
This high level of detail eliminates waste and provides a basis for comparing vendors’ performance against one another with our vendor management scorecard. We drive optimal performance and set best practices among all ancillary vendors to deliver better outcomes.
Our innovative ABM solution achieves significant cost savings through:
- Reduced unit costs
- Maximized network penetration
- Improved utilization management