Payer Vendor News from AHIP 2013
Many information technology vendors targeting health insurers made announcements of new products or acquisitions during AHIP 2013 in Las Vegas, including:
Many information technology vendors targeting health insurers made announcements of new products or acquisitions during AHIP 2013 in Las Vegas, including:
* Optum has launched a new business process outsourcing service for health insurers and will use the HealthRules financial, administrative and clinical transactions processing software from Health Edge to support the initiative. Services being offered to include claims editing, claims clearinghouse, data analysis, payment integrity, workflow integration, and fraud and abuse management functions, as well as services to support value-based payment programs such as pay-for-performance and accountable care organizations. More information is here.
* Medecision has introduced Aerial Consumer Care, a suite of care management content that payers can use to enhance their member Web portal and engage members. Functions include a questionnaire to gather information on members’ medical conditions, how they feel about the condition, their needs (such as better blood sugar monitoring), a risk assessment, and the ability to click an icon and talk to a care manager. The software uses member and payer information to generate an evidence-based care plan and, as well educational materials.
* PaySpan, a vendor of automated health care payment services to insurers, has launched enhanced provider enrollment and verification software to better ensure that payment is being made to the appropriate recipient. The Universal Provider Verification and Enrollment Service enables payers to apply additional levels of security to their payment processes. These include depositing a penny to a provider’s account to ensure it got there, and cross-checking other data sources to confirm provider identification. The software comes soon before the January 2014 deadline for using new operating rules with the HIPAA electronic remittance advice and electronic funds transfer transactions that made the transactions more uniform among insurers.
* Revenue cycle and claims clearinghouse vendor Emdeon Inc. has acquired Goold Health Systems, which sells pharmacy benefit management software to state Medicaid agencies. The software handles claims adjudication, ancillary administrative functions and data warehousing. The acquisition expands Emdeon’s reach into government pharmacy benefit programs.
* Optum has launched a new business process outsourcing service for health insurers and will use the HealthRules financial, administrative and clinical transactions processing software from Health Edge to support the initiative. Services being offered to include claims editing, claims clearinghouse, data analysis, payment integrity, workflow integration, and fraud and abuse management functions, as well as services to support value-based payment programs such as pay-for-performance and accountable care organizations. More information is here.
* Medecision has introduced Aerial Consumer Care, a suite of care management content that payers can use to enhance their member Web portal and engage members. Functions include a questionnaire to gather information on members’ medical conditions, how they feel about the condition, their needs (such as better blood sugar monitoring), a risk assessment, and the ability to click an icon and talk to a care manager. The software uses member and payer information to generate an evidence-based care plan and, as well educational materials.
* PaySpan, a vendor of automated health care payment services to insurers, has launched enhanced provider enrollment and verification software to better ensure that payment is being made to the appropriate recipient. The Universal Provider Verification and Enrollment Service enables payers to apply additional levels of security to their payment processes. These include depositing a penny to a provider’s account to ensure it got there, and cross-checking other data sources to confirm provider identification. The software comes soon before the January 2014 deadline for using new operating rules with the HIPAA electronic remittance advice and electronic funds transfer transactions that made the transactions more uniform among insurers.
* Revenue cycle and claims clearinghouse vendor Emdeon Inc. has acquired Goold Health Systems, which sells pharmacy benefit management software to state Medicaid agencies. The software handles claims adjudication, ancillary administrative functions and data warehousing. The acquisition expands Emdeon’s reach into government pharmacy benefit programs.
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