No man is an island. No company is, either. We find that we are all interdependent. Since we must frequently reach out to tap into the expertise of the best third parties, Beacon is determined to make it as easy as possible.
SpyGlass and HIPAA Director have a comprehensive set of tools to automate routing of claims internally and to third-party trading partners. Even multiple third parties. Whether to a simple repricing network, or for more complex code edits, or for third-party payment options, we allow healthcare payers to guide a claim completely through its automated life cycle. Easily control the routing to internal workflows and external trading partners with powerful rule ranking and user-defined business logic. Through custom parameters, routing controls logically handle complex inbound and outbound actions, while maintaining a complete audit trail for each claim. With SpyGlass routing features, our goal is to ensure actionable, more accurate data once it hits the SpyGlass auto-adjudication engine. Though most of the routing action happens behind the scenes, users can really see the benefits.
- Automation reduces turnaround time for claims
- Eliminates workarounds, human error, and data loss
- Minimizes the need for subsequent manual review during repricing and adjudication
- Accelerates and improves the efficiency of adjudication and payment cycle
The SpyGlass extensive internal routing capabilities allow users to determine exactly what the system does with received claims. For instance, should you route a claim to special workflow queue inside your operation, or should a claim go to a completely separate trading partner specialist? Healthcare payers can have their claims controlled by internal routing rule parameters and auto-adjudication controls that move claims into special repositories, so they can have tightly controlled, expedited life cycles. On an automatic and scheduled basis, the system can pull all claims from a particular workflow queue and navigate them through the check cycle process by virtually any criteria.
Alternatively, SpyGlass’ robust multi-layered external routing capabilities allow you to select claims for sending to a third party repricing service, via 837 or proprietary format, and receive claims repriced with discounts. However, if no response is received within a set number of days, the claim can automatically be “pulled back” and/or sent to an alternate repricer. An unlimited number of layers, just like this, are available to employ. These are not simply based on whether an incoming claim has no discount, but can be based on a whole wealth of claim criteria.
For instance, if a claim is from the main, in-network PPO, but it's for a chiropractic or mental health service, you’re able to pull that out and send it to a specialty network for repricing. These also frequently used to get mental health claims out to specialty networks. Although external routing in SpyGlass is most commonly used send to files to repricing vendors, they can also be used for code edits, fraud, or with any third party trading partner of your choosing. The SpyGlass reporting module provides you with the tools to monitor these claims, by helping you see which claims are not yet returned and the ability to process these claims, even if you’re still awaiting repricing.
Payers are under pressure to stay competitive in the ever-changing dynamics of the healthcare landscape. The key is finding flexible technology that adapts to changing businesses, reduce costs, and dramatically improve the efficiency of key operations. Beacon has developed our suite of comprehensive solutions with these factors in mind, allowing users to innovate the processes they have in place, improve their efficiency and profitability, and successfully grow their business.
When we work together, we're stronger than ever.
Give Beacon the opportunity to show you how the SpyGlass suite will allow you to devote your time away from manual review to more strategic efforts.