CAMBRIDGE, MA – In today’s healthcare environment, providers are under increasing pressure to know who’s paying for a patient’s medical care – often before that care takes place.
NaviMedix, a Cambridge, Mass.-based provider of healthcare communications between providers and payers, is diving into that arena with a series of business moves designed to create an “all-payer, all-patient” payment system. The company has acquired Topline Solutions, Inc., a provider of healthcare payment and collection solutions, and is partnering with ClearCycle, Ingenix and Moneris to set up its revenue cycle management platform.
The key to that platform, says Tom Morrison, vice president of marketing and product development at NaviMedix, is a system that accommodates health plans.
“Different plans are at different levels of providing payment estimates,” he says. “Those payers need to evolve along their own lines and still be supported.”
The evolution of consumer-directed health plans (CDHPs) has given patients more responsibility for paying healthcare costs – and it has forced providers to figure those payments more prominently in revenues. Morrison says the company’s new RCM solutions will enable providers to figure out up front how much of the cost of services is the responsibility of the patient, then reconcile patient and payer payments through the company’s NaviNet platform.
“This … is a critical piece of the equation to enable real-time adjudication in today’s complex healthcare payment infrastructure,” said Tim Hargarten, NaviMedix’s CEO. “It will accurately estimate patient financial responsibility and will easily reconcile payments from all sources.”
The company’s new platform will enable providers to determine, capture, process and reconcile patient responsibility for service; support reconciliation of all payments through a health plan’s transaction system; and allow for real-time claims adjudication.
“As an industry, we’ve always jumped to the end-stage – without looking at the process in between,” said Morrison. “This enables everyone to get sort of reduced to the lowest common denominator of capability.”
This fall, the AmeriHealth Family of Companies, the largest Medicaid managed care organization in the country, deployed NaviNet at five of its health plans – Mercy Health, AmeriHealth Mercy Health, MDWise Hoosier Alliance, Passport Health and Select Health of South Carolina – and will soon deploy the platform at Horizon NJ Health.
“Working with NaviMedix for our provider communications enables us to quickly roll out sophisticated services across all our lines of business and support our network providers in delivering high-quality care to an often underserved patient population,” said Jay Feldstein, senior vice president and corporate chief medical officer of AmeriHealth Mercy.