Health Cost Solutions hasn’t heard the telephone ring often since switching to a hosted claims editing service.
The Henderson, Tenn.-based Third Party Administrator of health plans serving some 30,000 employees across the Southeast switched recently from its traditional claims editing application to Bloodhound Technologies’ ConVergence Point.
Tawanda Travis, vice president of information technology for HCS, said the company has processed more than 10,000 edits since switching to Bloodhound, and she can count on one hand the number of phone calls they’ve received from physicians wanting to know why claims were denied.
“As a TPA, service is often the only thing you can provide to set yourself apart from the competition,” she said in a press release supplied by Bloodhound. “Our challenge is that we have multiple stakeholders with different needs to service. Clients want to control their healthcare costs, employees want the best coverage and care, and physicians want to be paid promptly and fairly. ConVergence Point allows us to use technology to improve our processes and service our stakeholders.”
ConVergence Point, which was launched in February, uses pre-adjudication editing tools to process a claim. In addition, the application opens the portal to both sides of the bill, allowing providers to know whether their claim will be denied ahead of time and enabling them to corrections at the beginning of the process. Bloodhound officials say the edits are based on national standards and can be adapted to fit any payer’s reimbursement policies.
“For TPAs like Health Cost Solutions, ConVergence Point eliminates conflict between payers and providers by delivering full transparency into the claims editing process,” said Gary Twigg, CEO for Durham, N.C.-based Bloodhound. “Patients are not back billed for claims that insurers have edited, and doctors are not calling to see why their claims have been denied. As a result, Health Cost Solutions is able to concentrate on differentiating itself from competitors by delivering an increasingly higher quality of service.”