Value Added Performance
BPaaS + Connected Partners
Since its inception, MedVision has continued to review and establish key services and industry relationships in order to add expanded value to its aligned clientele and healthcare partnerships. Our Value-Added Performance model achieves exactly that – it helps clients reach higher degrees in workflow efficiency and process improvement resulting in more cost savings.
Value Added:
Business Process as a Service (BPaaS) - Effective Resource Alignment
Organizations today whether operating from a start-up perspective or gearing up for a growth expansion mode can benefit from improved resource utilization through MedVision’s BPaaS, Business Process as a Service, option. BPaaS relieves burdensome tasks that organizations face internally during growth, restructure, or in their quest to better control on-going operational costs.
BPaaS
Task Management Services
Membership
Routine loading of enrollment, eligibility and revenue or capitation files based on health plan frequency - performing necessary reconciliation tasks and reporting
Encounters
Encounter processing and submission to health plans – ensuring timeliness requirements are met in network performance
Providers
Loading and updating provider records and contract alignments – ensuring accurate reimbursement to contracted providers
Health Plans
Configuration of existing or new health plan agreements, reimbursement and carve-out structures or methods with network and out of network provider organizations – allowing consistent structure in upstream and downstream arrangements
Reporting
Generating the required timely output of utilization, authorization and claims turn-times of standard and custom report formats required by health plan partners – ensuring compliance of critical delegated processes
Workflow
Building and maintaining each configurable rule that impacts the routing of or the approval, denial and pend processes of referrals, authorizations, or claims environments of the delegated value-based organization
BPaaS
Operations Management Services
Credentialing
Maintenance of full provider profiles and necessary triggers to keep data continuously up to date – complying with all delegation authorities, updating through all required primary or secondary source verifications
Referrals Processing
Ability to manage the complete utilization cycle based on approved medical criteria – streamlining the authorization process per organization’s guideline policies and procedure directives
Claims Administration
Providing end to end processing and accurate adjudication of provider and facility claims up to and including payment and distribution processes
Capitation
Ability to act as the financial arm to manage outbound processed capitation payments along with reconciled member reports to providers. Provide health plan trending analysis and utilization patterns to detect network leakage
Contract Negotiation
Experienced executive teams that are able to place a critical lens on contracts and structures across all stakeholders of the network including plans, providers, specialists, facilities and ancillary services. They are designed to work on your behalf to bring meaningful resolve and next step positive impact to your bottom line.
Call Center Operations
Maintenance of a full cycle Customer Service department with an ability to track all in-bound inquiries, routing to appropriate personnel, integration with applicable department structures such as claims and referrals for more rapid call solutioning and resolutions
Connected Partners
MedVision has created alignment strategies allowing client partners a full service and a more complete approach to their operational needs. Options allow for direct relationships or as a business process service, invoking a best-in-breed approach.
Apollo Managed Care – AMC has been a trusted resource for many RBOs, plans, TPAs, specialty organizations, and management firms providing medical review criteria and guidelines that assist in identifying case management and treatment options that are appropriate and medically necessary. Apollo’s online medical review criteria and guidelines are 100% evidence-based and its framework facilitates rapid integration with existing Utilization Management and Care Management systems.
ClinigenceHealth – CH transforms data into a holistic view of a population or individual member/patient with the ability to drill down by cost, provider, disease, risk, and age to identify clinical drivers of cost and quality. Population health, risk stratification, and integrated predictive modeling are key components to anticipate and intervene in situations before an adverse event occurs.
Dolphin HealthRx – Dolphin is a URAC approved specialty care pharmacy. Working through plans, providers, FQHCs, and RBOs, Dolphin aligns its cost-effective strategies serving the chronically ill and other key populations such as SNFs and nursing homes through its patented robotics platform DosePack. This ensures timely and more cost-effective medication dispensing and delivery management.
DosePack – DosePack in conjunction with MyDoses is a complete robotics-based medication dispensing, packaging, shipping and adherence platform. In unison with key pharmacist staff, it allows for a comprehensive workflow and management approach to help bend the cost curve in healthcare today, meeting the patient needs with a more effective follow through in patient care.
Dr. Catalyst – DC provides comprehensive back office remote personnel services. Supporting services include billing, administrative, and marketing tasks allowing providers and organizations to remain focused on patient care and outcomes.
HealthSentry – HS is a blockchain based systematic method for auditing, monitoring, recording, verifying, and executing healthcare communications, decisions, and transactions. HS provides incorruptible recording and tamper proof storing of all events and works to eliminate errors and fraudulent activities, ensuring the greatest level of compliance with any governmental or oversight agency.
Meditab Inc – Meditab’s Intelligent Medical Software (IMS) is the most cost-beneficial All-in-One EHR, Practice Management, and Billing Software solution today. It provides a direct integration to MedVision’s QC7 payor product. The IMS product is a highly customizable solution for any specialty group or practice. It has also pioneered a fully featured mobile EHR application tool for providers, staff, and patients allowing practices to run more efficiently and effectively.
Nexus HR streamlines and manages all recruiting, personnel management, training, succession planning, and payroll for organizations of any size. Nexus HR eliminates the busy work in personnel administration and allows you to focus on your more critical operational needs.
nThrive – nThrive’s product ClaimShop is a directly integrated product to MedVision’s QC7. It provides a comprehensive DRG / APG pricing approach to process and manage inpatient claims for effectively and with greater accuracy. The tightly knitted communication allows users to see exactly all the components making up the pricing strategy and algorithm.
PCG Software - PCG works with healthcare payor / provider organizations to increase profitability by enhancing cost containment, maximizing financial recoveries, and significantly reducing fraud and abuse. The software tools automate cost containment through more accurate and efficient claims adjudication and code review. PCG’s product Virtual Examiner (VE) as an option, is directly integrated to MedVision’s QC7 application today.
Sierra Health Alerts - Works with multiple Health Plans, Independent Provider Associations (IPA), Rural Health Centers (RHC), Federally Qualified Health Centers (FQHC), Surgery Centers (ASC), and Private practice. Provides high-quality care to patients through innovative comprehensive tools. They help doctors who use their system achieve high performance in HEDIS/STARS, CAHPS and HCC/RAF.
Through comprehensive partner alignment, MedVision provides the most optimized approach in managing all of the detailed operational needs of any payor based organization today. For a no-obligation review of services and approach specific to your organization reach us today at 847-222-1006 or via email at info@quickcap.net.
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The Health Information Trust (HITRUST) is a standards organization dedicated to security, privacy, and risk management. They developed the HITRUST Common Security Framework (CSF), which assists organizations in maintaining a comprehensive and secure approach to HIPAA compliance and managing risks. HITRUST is widely recognized as the benchmark in data security and privacy.
Certified Member of HCAA
The Health Care Administrators Association is the nation's largest nonprofit trade association for third-party administrators, stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, and health care consultants. HCAA has spearheaded the change of self-funding for more than 35 years.
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