There’s a Rule for That

To serve a market driven by evolution and change, healthcare payers are under increasing pressure to simplify operations and increase automation across their business. As a key component of any payer’s operations, a configurable, rules-driven claims administration system is an integral part of that success. Too many person-hours are spent on tasks that could be automated when given the right technology. Rules-based logic is at the heart of SpyGlass’ automated and adaptive process. For any core administration task in need of automating – in SpyGlass, there’s a rule for that.

SpyGlass contains a full suite of modules that includes everything a payer organization needs to automate and manage their data and operations. With its intelligent rules-based engine, the application performs automated deductions around all critical healthcare payer processes based on your unique configurations. We’ve designed these easy-to-use rules to be configured by business users to give your enterprise flexibility to capitalize on new growth opportunities. Running reports, writing letters, routing claims, and exchanging files with your trading partners are just a few of the numerous responsibilities that no longer require human intervention.

For example, SpyGlass makes it easy to configure rules to automate complex benefit calculations and drive high auto-adjudication rates. Plan setup for benefits is rules-driven on the use of HIPAA required code sets. These rules define co-pays, networks, co-insurances, service and dollar limits, benefit groups, tiered benefits, benefit penalties, and member/patient demographics. We’ve embedded workflow into our benefit configuration process, allowing users to easily control their desired level of auto-adjudication. As a bonus, SpyGlass also contains dozens of auto-adjudication rules that are designed to allow unique settings for any group/trading partner combination.

Claim auto-adjudication rates are just the tip of the iceberg when considering how to automate your operations. The secure, smooth automatic exchange of files can make a world of difference to an operation. HIPAA Director, included with the SpyGlass suite, does this for you, without having to purchase an external EDI gateway product. Other operations, like communicating with your stakeholders, are much easier when the application places automation tools at your fingertips. SpyGlass’ integration with Microsoft Word that lets you leverage the tools you already know via our correspondence module. Using virtually any field or combination of fields in the database, the system brings all the powerful formatting and processing options available right to you. We add to that with auto-generation of documents, auto follow-up documents, and customizable quiet periods.

The SpyGlass enterprise suite has helped many payer organizations replace antiquated, inefficient legacy systems by improving flexibility, reliability, and profitability. One customer maintained an auto-adjudication rate of over 90%, while another significantly decreased their backlog with our customer service capabilities.

We thoughtfully developed our technology suite to help our clients stay ahead of competitive market demands with confidence while constantly improving results. Beacon’s smart rules-based methodologies ensure that our clients are maximizing their technology investment, making increasingly efficient use of valuable human resources. Transform your organization and face the ever-changing healthcare market head-on with a rules-based system that accommodates all of your business needs in a single, fully integrated solution.

Why not give Beacon SpyGlass a try and see just how useful a rules-based system can be for your business.

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