Hospital Contract Management with
InSight Payment Variance Analyzer™
Eliminate Underpayments and Ensure the Contracted Amount for Every Claim
While many organizations have systems in place to flag, address and appeal denied claims; there are also millions of dollars in underpayments – claims paid at rates in variance to payor contracts – that go unnoticed and unaddressed every day.
Your organization fights hard to secure the most favorable contractual rates it can. Don’t allow payor organizations that are unable or unwilling to ensure proper payments to nullify those hard-won concessions.
InSight Payment Variance Analyzer is the most comprehensive tool available today for analyzing remittance data to identify and work underpayments. It analyzes paid claims line-by-line and reports on payments at variance to your most recently contracted rates. It identifies likely errors such as claims paid according to the rates for similar plans, while helping you recover revenue that you are contractually entitled to.
Underpayment Identification and Tracking
InSight Payment Variance Analyzer analyzes all 835 remittance data and automatically compares actual reimbursements to the contracted rates for each payor. It Allows billing and appeals staff to view the specific reimbursement calculation used to determine expected payment amounts as well as view a detailed display of the payor transaction on the remittance.
Contract Management
InSight Payment Variance Analyzer helps you identify and address all underpayments with a robust set of contract management tools that ensure you are always working with the latest iteration of every payor contract. The Craneware InSight reimbursement staff use contract management tools to configure the system to manage all of your service and reimbursement types, including carve-outs, stop-loss and more. The system is also designed to detect and adjust remittance analysis as changes are made to any contracts.
The sophisticated claims analysis tools also help reduce false variances due to registration errors. For example, it is not uncommon for registration staff to note the wrong plan on a claim and for the payor to pay the claim at the rate of the actual subscriber plan. InSight Payment Variance Analyzer identifies this automatically so you don’t spend time chasing something that was properly paid.
Sophisticated Reports and Analysis
Detailed reconciliation reports identify all “no-match” items – claims that lack remittance or remittances that lack claims – to facilitate efficient investigations. General reporting tools allow you to easily chart or export any data element into Microsoft Excel®, to view information ranging from payor comparisons to drill-down line-item-level reports.
Key trending reports measure the impact of underpayment analysis, appeals and process improvements to provide valuable insight into the impact of payment variance on overall revenue cycle performance. You can even track and measure underpayment recovery effort success with metrics that tie total underpayments indentified to actual dollars recovered. And because we understand that every organization has its own unique reporting needs, we go beyond 835 elements with customized data elements so you can run reports on a wide range of criteria, including by location and by account number.
