While reducing administrative costs and increasing payment accuracy, an advanced claims pricer, McKesson Reimbursement Manager, has been introduced by McKesson to help health plans administer more complex reimbursement strategies — for example, combinations of fee for service and newer models such as bundled payments for episodes of care. As healthcare transitions to new care delivery and reimbursement models that recognize value over volume, this capability is a critical success factor for plans.
“Legacy claim systems can have tremendous difficulty sorting out which medical, payment and provider contract policies apply to a given claim when relatively straightforward fee-for-service payments are involved,” said James Evans, VP, Financial and Network Management, McKesson Health Solutions.
He added that health plans gain the flexibility to develop, reinforce and benefit from even the most intricate reimbursement combinations with McKesson Reimbursement Manager while keeping administrative costs low and payment accuracy high through greater automation. McKesson Reimbursement Manager helps health plans create, centralize and optimize provider reimbursement arrangements.
By identifying the correct provider reimbursement rate based on member, product, provider, service and client-specific attributes, the advanced pricer supports a combination of different reimbursement models. Health plans can automate the entire reimbursement lifecycle when McKesson Reimbursement Manager is used in conjunction with two additional solutions from McKesson —McKesson Provider Gateway for provider and contract selection transactions and ClaimsXten for advanced claims editing.
By applying the correct medical, payment and reimbursement policies into a single, integrated process that calculates the appropriate allowed amount during claims adjudication, these products can together help simplify provider reimbursement. These can be contract-specific or standard health plan policies.
Evans concluded that health plans will find it increasingly difficult to effectively compete in such a dynamic marketplace without the appropriate infrastructure in place to keep policies in alignment. Currently ranked 14th on the FORTUNE 500, dedicated to making the business of healthcare run better, McKesson Corporation is a healthcare services and information technology company.
Edited by
Brooke Neuman
