Payment Accuracy Services
Supplement your existing overpayment identification program to capture additional savings opportunitiesThe Challenge
In today’s challenging healthcare environment, health plans are determined to reduce annual claim spend and to lower the cost of healthcare to their members and employers. Due to the complexity of our healthcare delivery systems, billions of dollars are paid in error each year. Not only do errors impact payers and providers but the added administrative costs associated with identification, validation and resolution of any discrepancy is exponentially more costly and often impacts the member experience. Many payers have existing payment integrity programs but TREND’s direct payer experience demonstrates that additional opportunity exists to enhance these efforts and capture significant savings missed by current programs.
The Solution
TREND provides Payment Accuracy Services designed to complement any overpayment identification program provided by a commercial or governmental sponsored health plan. We identify overpayments that are the result of complex claim billing and payment scenarios. Custom algorithms and multi-dimensional data modeling techniques allow TREND to deliver value to our clients through several flexible service delivery methods. We identify and resolve a wide spectrum of overpayments, including scenarios missed by first pass vendors, and offer options to utilize our on-site resources and resolve overpayments directly with specific providers. This added level of handling ensures accuracy, increases speed of resolution, lowers administrative cost and maximizes recoveries.
Your Payment Accuracy Solution
TREND recognizes that health plans want to identify all their claims payment leakage, but other considerations are also important such as the resources required to implement and manage another vendor. Understanding these business needs, TREND developed an advanced payment accuracy technology platform to address these concerns. TRENDMiner was developed based on expertise with healthcare data and a detailed understanding of payer claim recovery and provider revenue cycle processes. TREND’s innovative technology significantly reduces overall processing time and improves results with transparent communication and effective workflow management.
Payment Accuracy Services
Due to the complexity of our healthcare delivery systems, billions of dollars are paid in error each year with up to 7% leakage coming from the commercial market and 10% coming from the government market. TREND’s Payment Accuracy Services are designed to use an advanced technology platform and proven claim and account data modeling techniques to identify and resolve payment errors at scale and in a transparent and collaborative manner. TREND also delivers fully validated claims and superior root cause analysis enabling corrective action methods for each plan to reduce overpaid claims in the future.
Incremental Recovery
TREND focuses on complex claim scenarios not identified by the current program. Advanced data analytics are critical to the successful identification of new and different overpaid claims. By applying TREND’s overpayment analytics to your existing program, you can quickly and efficiently capture additional overpayment recoveries missed by your 1st or 2nd pass vendor and increase the value of your overall claim recovery program.
Easy/Low Cost Implementation
TREND’s technology is designed to support your existing data files so the internal work effort and cost to deploy our services is low. Unlike most vendors, TREND also delivers fully validated claims and superior root cause analysis so you can save valuable resources and prevent future overpayments. TREND’s high quality results ensure the overall financial impact and return on investment to your recovery program is very high.
State-of-the-Art Technology
TRENDConnect was developed based on expertise with healthcare claims data and a detailed understanding of the payer’s claim recovery processes and the provider’s revenue cycle processes. Our application provides transparent communication, comprehensive reporting and more efficient and effective workflow management. TREND’s unique system significantly reduces overall processing time and improves your bottom line.
Claim Analytics
Cutting Edge & Advanced- Effectively integrate the power of data from multiple sources
- Accurately target potential billing and payment issues
- Go deeper into your data to uncover overpayments missed by current processes
- Decrease your administrative expense and overall claim spend
Overpayment ID
Various Options for Recovery- Support your plan’s unique processes with custom concept development
- Capture additional recoveries missed by existing programs
- Enhance your existing program by implementing multiple pass options
- Improve claims processing accuracy and decrease medical claim cost
RADAR
Incrementally More Recoveries- Innovative process increases credit balance recoveries
- Combine audit results with multiple payer and provider data sources
- Advanced analytics identify additional recovery opportunities often missed
- Faster and more efficient recovery when combined with TREND’s on-site reviews
Consulting
Cost Containment Focused- Prevent known overpayment scenarios from occurring on future claims
- Increase cost savings through process improvements designed specifically for your organization’s workflow
- Drive innovation and efficiencies with our comprehensive experience in the Payment Integrity industry
Our Service Modules
Below are the service modules found in TRENDConnect which support our Payment Accuracy Service:
TRENDResolve is a game-changer
Secure, cloud-based application
Our unique solutions are built on an advanced HIPAA-compliant, cloud-based technology platform that helps our payer partners to reduce redundancy, minimize cost, and manage resources more effectively.
Built from the ground up
Our application is a comprehensive, technology enabled solution created from a configurable suite of business process modules designed to minimize the cost and maximize the efficiency of the payer’s payment integrity program.
Dynamic dashboard reporting
TRENDResolve provides real-time status changes, an accurate audit trail and comprehensive reporting to provide key insights while more effectively managing this costly business requirement.
