Dear Colleague,

Insurance carriers hold the reimbursement purse-strings in healthcare today and, as a result, they have an undeniable impact on the financial well-being of physician practices. Under these circumstances, it becomes essential to monitor payer relationships closely to ensure they honor agreed-upon rates and issue reimbursement in a timely manner.

And when it comes to making payers accountable, knowledge is power. That’s why Navicure offers clients progressive reporting and analysis tools, and is in the process of developing advanced functionality that will put even more valuable data in their hands.

Navicure electronic status reports and activity logs currently show the path of every claim so practices can identify and correct problems that arise during the reimbursement process. Vital information that would be difficult to access manually can be easily produced with a few clicks of the mouse.

One of the most beneficial uses for this data is resolving issues between the practice and payer. Perhaps a payer denies receipt of a claim. Navicure can document the date and time it was submitted, which indicates the problem occurred within the payer’s system, impeding the claim’s arrival in the adjudication department. In cases like these, the Navicure claims status report will be accepted as proof of timely submission. This not only resolves the payment dispute, but gives the practice the option to levy interest charges on balances not paid within the “timely reimbursement” period mandated by each state.

In the near future, Navicure is committed to offering analysis tools that provide an even greater strategic advantage. One primary objective, for instance, is to provide aggregate data that will help practices critically assess the value of each payer relationship and support efforts to negotiate profitable contracts.

Such reports could track and summarize information like:

• Rates that each insurer pays for a specific service;
• Average reimbursement from each payer;
• How quickly specific payers reimburse claims;
• Number of rejections per 1,000 claims; and
• Percentage of claims rejected or denied by a particular payer.

This type of information would reveal the intangible costs of working with each insurer. Let’s say Payer A pays $100 per procedure, while Payer B pays only $85. However, Payer A denies 50% of the claims, which staff must then re-work. New data-mining capabilities would allow a practice to analyze which payer relationship is truly most productive and allow them to negotiate contracts accordingly. When payers try to establish lower rates by arguing they are “easier” to work with, for instance, Navicure clients would be able to validate or deny their assertions with factual data.

In addition, Navicure is developing functionality to compare payer performance nationally and regionally – information that would provide a valuable perspective at the negotiating table.

There is no doubt that ensuring timely and fair payment is an ongoing challenge for practices today. Navicure is committed to developing functionality that will make relevant and actionable information easily accessible, empowering our clients with knowledge they need to hold payers accountable.

Sincerely,

Jim Denny
President
jdenny@navicure.com

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