HealthNow Will Implement MedAssurant's Solutions for Improving Risk Score and Claims Submission Process Accuracy
BOWIE, Md., Jan. 31, 2012 /PRNewswire/ -- MedAssurant, Inc., a leading provider of data-driven healthcare solutions, today announced that HealthNow New York Inc., parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, has selected MedAssurant to support its focus on disease, comorbidity, and related risk score data accuracy for Medicare Advantage and Medicaid members.
Through a combined implementation of MedAssurant's Capitated Risk Adjustment (CARA™), Claims Aggregation Analysis and Submission (CAAS™), and eCAAS Advantage™ solutions, MedAssurant will help HealthNow increase Medicaid diagnosis data accuracy and both meet CMS' current risk adjustment processing system (RAPS) requirements and concurrently support its transition to CMS' new 5010-compliant encounter data submissions (EDS) requirements.
"HealthNow is committed to delivering the highest level of effective care to our members through data integrity and data submission programs that enable high-quality and cost-effective care to our members," said Jared Gross, Vice President of Healthcare Economics at HealthNow New York. "Our partnership with MedAssurant provides us several key components necessary to advance our corporate initiatives in these areas."
"HealthNow is known not only for being a premier health benefits and information company providing quality healthcare services to employers and members but also for its dedication to providing the best-managed and most forward-thinking healthcare solutions available," said Keith Dunleavy, M.D., President and Chief Executive Officer of MedAssurant. "We are very pleased to be partnering with HealthNow to complement their innovative set of healthcare services to New York."
About the Solutions
- CARA™ is a retrospective risk adjustment solution providing a highly data-driven approach to the efficient identification, determination and substantiation of disease and comorbid condition data. Advanced analytics leverage insight gained from extensive clinical datasets of more than 5.2 billion medical events to identify potential gaps in disease and comorbidity data accuracy. A highly integrated platform designed to coordinate both EMR and paper-based medical record data aggregation thereafter facilitates a highly efficient process of "filling in the gaps" through the targeted abstraction of both discrete and non-discrete clinical data. This process results in a more thorough understanding of each member and a more comprehensive risk score value to ensure significant improvement in healthcare data, quality insight, and risk score accuracy.
- CAAS™ aggregates, analyzes, reconciles and prepares submissions of risk adjustment data, performing the vast set of processes necessary to meet CMS risk adjustment processing system (RAPS) requirements. CAAS then provides the detailed reconciliations and management-level reporting health plans need to achieve timely reimbursement, forecast budgets, prepare bids and meet financial reporting requirements.
- eCAAS Advantage™ provides a comprehensive claims processing and risk adjusted financial valuation solution to address CMS's transition from RAPS-based submissions to the new 5010-format encounter data submissions. eCAAS Advantage leverages industry-leading claims integrity and processing technologies to deliver an agile encounter solution that provides data integration, analysis and reporting. It offers Medicare Advantage organizations a solution for all types of claims and provides the flexibility to manage all encounter files and data in a single application and database, while meeting CMS-mandated compliance requirements. eCAAS Advantage has been certified by CMS for Encounter Data Front-End Testing.
About HealthNow New York Inc.
HealthNow New York Inc. is one of New York's leading healthcare companies that provide access to quality healthcare and innovative solutions for members throughout upstate New York. Headquartered in Buffalo, New York, the company is an independent Licensee of the BlueCross BlueShield Association.
About MedAssurant, Inc.
MedAssurant, Inc., is a leading technology-enabled healthcare solutions provider focused on the importance of healthcare data and its ability to drive dramatic, objective improvement in clinical and quality outcomes, care management and financial performance throughout the healthcare community. Proprietary healthcare datasets, aggregation and analysis capabilities, combined with a national infrastructure of leading-edge technology, clinical prowess and deep human resources, empower MedAssurant's advanced generation of healthcare assessment and improvement through highly informed solutions. Driven by a mission to improve today's healthcare landscape, the employees of MedAssurant proudly apply care, ingenuity and dedication to delivering a new approach to healthcare touching more than 100 million Americans – one driven by data and insight – one resulting in meaningful action. Please visit www.medassurant.com for more information.
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SOURCE MedAssurant, Inc.