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Claim Management

Rapidly configure complex rules, benefits, and/or contracts to improve auto-adjudication

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Encounter Management

Correct encounter data
prior to submission with VIDACounter™

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Eligibility Management

Invidasys technology allows for easy access to eligibility information from multiple sources in real-time

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Provider Management

Enable your organization to manage complex provider associations effectively

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CLAIM MANAGEMENT

Cloud-based claim processing and adjudication solution for commercial, Medicare, Medicaid, and Public Exchange markets that reduces cost of technology ownership and allows for rapid implementations.

With the ever-changing health care industry, healthcare organizations need to be more agile in addressing their information management needs. The cost of technology ownership can be a huge obstacle to comply and keep up with the changing market needs. Moreover, the evolving regulations and their implications are being tied to organizations’ revenue and profitability more than before. VIDAClaim™ is the solution for the emerging needs by leveraging the cloud technology.

BENEFITS

  • Reduces cost of ownership by leveraging Cloud technology, allowing for faster implementations
  • Increases payment accuracy and provider satisfaction by streamlining claims processing
  • Enables organizations to tune the adjudication process to their specific needs
  • Allows rapid configuration of complex rules, benefits and/or contracts

ADVANTAGES

  • Boosts first-pass clean claim rate and auto-adjudication
  • Utilizes an advanced claim validation and provider-member matching
  • Determines claim disposition with manual pricing capability
  • Verifies current claims against paid claims to prevent duplicate payments
  • Enables users to edit claims in real-time and during EDI process
  • Allows developing of custom rules and user-defined filters
  • Enables end users to define custom workflow queues
  • Integrates seamlessly with third-party and client-developed software composites
  • Maintains finalized claims history in separate indexed partitions

See VIDAClaim in Action. Schedule an in depth demo.

ENCOUNTER MANAGEMENT

Cloud-based encounter data management solution for Medicare, Medicaid, TRICARE, and Public Exchange encounter processing that creates compliant files ready for submission with over 95% first pass clean rate.

Managing the accuracy and timeliness of encounter submissions is paramount to health plans’ revenue, profitability and compliance. To make this process proactive, automated, accurate, and easy to track, Invidasys has created VIDACounter™.

VIDACounter™ is a plug-and-play cloud-based encounter data management solution that solves the problem of claims’ bad data through its proprietary complex rules which scrub and clean data, extract and populate the missing data and create a HIPAA compliant file ready for submission. The solution automatically validates each encounter prior to submission which greatly reduces the likelihood of rejections. This helps health plans to avoid paying penalties for late and inaccurate encounter submissions.

BENEFITS

  • Manages the accuracy and timeliness of encounter submissions
  • Avoid penalties associated with late and inaccurate encounter submissions
  • Robust built-in reporting and dashboard capabilities providing critical financial and compliance reports

ADVANTAGES

  • Creates HIPAA compliant encounter submissions to State Medicaid Plans and CMS
  • Automatically validates each encounter prior to submission through business workflows, which greatly reduces the instances of rejected submissions
  • Multiple EDI encounter file types can be processed
  • The component can be configured for flat file or proprietary formats based on business needs
  • Load third-party encounters to manage all encounter data within one system
  • User-Interface for viewing the encounter file in a readable view

See VIDACounter in Action. Schedule an in depth demo.

ELIGIBILITY MANAGEMENT

Cloud-based member enrollment and eligibility data management solution for commercial, Medicare, Medicaid, and Public Exchange markets that enhances user visibility during the entire life-cycle of eligibility information.

VIDABility™ is a comprehensive solution that manages the coverage and relationships of insured members and their dependents and increases the visibility during the entire lifecycle of enrollment history. It provides easy access to member eligibility information from multiple sources in real-time while maintaining the most accurate eligibility data, in one place, all the time.

BENEFITS

  • Simplifies and improves member administration via member-centric architecture and access to real-time data
  • Transactions are driven by workflow steps, this model will allow users to effectively make changes without development work
  • Provides single source and visibility into the member transactions via user interface for improved customer service
  • Adaptable to meet changing business needs and scalable to meet growth demands

ADVANTAGES

  • Manages enrollment and eligibility records for Medicaid and commercial exchange
  • Allows Medicare Advantage eligibility processing and maintenance:
    • Enrollment request processing (MARx)
    • Updating enrollment statuses
    • Benefit Eligibility Query (BEQ) request and response processing
    • CMS enrollment response processing (DTRR)
    • Handles HICN to MBI Crosswalk for member matching
  • Enables configuration of coverage levels, relationships and vendors
  • Allows member-provider assignment functionality, changes and tracking
  • Permits unlimited benefit packages and premium structures
  • Eliminates duplicate data entry and associated complexity and problems
  • Allows unlimited insurance and relation tracking of insured members and any related entities
  • Ensures most accurate data is available in real-time
  • Provides transaction history traceability by member

See VIDABility in Action. Schedule an in depth demo.

BENEFIT PLAN MANAGEMENT

Cloud-based benefit plan administration solution for commercial, Medicare, Medicaid, and Public Exchange markets that enables organizations to rapidly adopt new and emerging benefit models.

As the types of benefit packages being offered to insured members continues to expand, it becomes increasingly important to have the ability to rapidly deploy new benefit options and quickly mix and match benefits from a variety of sources to create custom benefit packages. VIDAPlan™ provides you with such a flexibility.

BENEFITS

  • Simplifies and improves benefit plan administration by flexible design and access to real-time data
  • Streamlines maintenance of benefits and packages utilizing several built-in and time-saving business best practices
  • Allows the organization to quickly respond to market demand and create competitive benefit plans
  • Enables the organization to adopt emerging plan models and create innovative packages

ADVANTAGES

  • Allows to create and manage multiple benefits and the associated grouping of benefits (a package)
  • Allows copying of benefit plans, making the plan benefit building process quick and efficient
  • Provides flexible plan associations, e.g. packages can be associated with individual members or with groups of members
  • Permits multiple packages to be assigned to a member concurrently when integrated to other VIDASuite™ modules
  • Allows benefits to be assigned to multiple packages
  • Enables users to define benefit priority to ensure that the system handles overlapping benefits in accordance with the insurers’ guidelines
  • Allows user-defined code groupings within the code sets
  • Permits unlimited user-defined accumulation periods
  • Designed to allow for real-time interaction with claim processing system to provide benefit-determination services
  • Allows the ‘stacking’ of accruals and limits to a single benefit to ensure accurate and timely capture of limits; even when the limits are from different buckets (i.e. annual versus lifetime)

See VIDAPlan in Action. Schedule an in depth demo.

PROVIDER MANAGEMENT

Cloud-based provider and network data management solution for managing complex provider relationships, networks, facilities and contracts with a flexible and scalable approach.

Healthcare organizations are faced with an ever changing and demanding regulatory environment that requires constant compliance updates and consistent processing. In addition, there are a growing number of complex associations between providers, doctors, groups, hospitals and insured members. Managing the accuracy and consistency of provider information, along with the provider information as it relates to each association or relationship, has become very challenging.

BENEFITS

  • Provides scalability and flexibility to create unlimited relationships between networks, providers, service locations and line of business
  • Enhances productivity through access to a real-time single database of providers information and complex associations

ADVANTAGES

  • Utilizes a unique four-tier system to create and manage complex and multiple relationships and multiple Lines of Business
  • Allows viewing of information that is relevant for a particular provider type, e.g. facility vs. physician through its provider-type centric user interface
  • Prevents duplicate Provider data entry based on a unique duplication review process that includes NPI, Tax ID and other provider data points
  • Has a built-in API call out and database reference from NPPES with the ability to verify provider status and update missing provider data points
  • Ability to do user defined mass external Provider data uploads with:
    • User visibility of data during the process
    • User data corrections or rejections during the process
    • User defined business rules applied to the workflows that manage the process
  • Ability to interface with core healthcare systems, serving as a record of truth for more accurate claims processing, provider directories and any provider data extracts needed

See VIDAPro in Action. Schedule an in depth demo.

CONTRACT MANAGEMENT

Cloud-based provider and facility contract management solution that is highly flexible and configurable to the specific needs of the organization.

Emerging new business models like ACOs and value-based reimbursement and ever increasing provider network consolidations require more flexible approach for contract management to ensure proper pricing and payments. VIDAContract™ simplifies managing contracts for health care payers to overcome the increasing complexities.

BENEFITS

  • Increases productivity by simplifying and streamlining contract management
  • Improves organization’s performance through accurate pricing and payments

ADVANTAGES

  •  Allows the end-user to add single or multiple coverage groups to a contract and assign a fee schedule or a payment methodology (i.e. percent of billed charges) to a coverage
  • Handles all types of payment methods to calculate payments, including per diem, variable per diem, case rate, flat rate, percent of billed charges and capitation
  • Identifies contracts as Participating (PAR) or Non-Participating (Non-PAR)
  • Assigns PAR and Non-PAR contracts per a Line of Business (LOB)
  • Enables configuration of authorization requirements, assignment of rates to a fee schedule and defines effective and termination dates at the contract coverage level
  • Allows configuration of bill types at the contract-coverage level as well as specific place(s) of service; provider types and provider specialties
  • Ability to flag a contract coverage to pend a claim for manual review
  • Able to apply timely filing days per State or Federal requirements

See VIDAContract in Action. Schedule an in depth demo.

CLAIM SCRUBBING

Cloud-based EDI Gateway solution for health care payers, that can receive, clean and submit HIPAA compliant files.

One of the administrative burdens for health plans and health care payers is to process all the EDI files that are being required. VIDAPass™ resolves this problem because it can receive as well as submit all the EDI files from Membership, to Claims, to Claim responses as well as Provider Directories. A second major burden is receiving “dirty” claims that can slow down claims processing and eventually cause Encounter Data submission problems. VIDAPass™ resolves this problem with a front-end rejection of transactions with critical errors. In addition, based on standard and user-defined rules and edits, corrects transactions with non-critical errors up-front before they are submitted to an adjudication system.

BENEFITS

  • Reduces the percentage of human error and improves the number of clean claims submitted
  • Reduces the administrative costs associated with claims and encounter processing
  • Enhances the efficiency and productivity of the adjudication process by increasing the first-pass clean claim rate and utilizing auto-corrections
  • Increases the speed of claim processing
  • Provides a user interface of the EDI files

ADVANTAGES

  • Ability to reject Transactions for reasons such as:
    • Member eligibility
    • Provider participation
    • Invalid codes
    • Improper dates and date spans
    • Non-compliant State and or Federal billing regulations
    • Invalid Lines of Business
  • Ability to filter and clean data from other sources such as:
    • Eligibility files
    • Provider files
    • Claim files
    • Reference files
    • Core Admin files
    • Portal files
    • Third-Party Vendor files
  • Serves as an EDI Gateway for core admin platforms
  • Cleans up Transactions which increases:
    • Claim Auto-adjudication
    • Cleaner Encounter data
    • Cleaner data for better fiscal reporting

See VIDAPass in Action. Schedule an in depth demo.

ADDITIONAL SOLUTIONS AND SERVICES

We partner with you; Solving problems with creative excellence.

As business and government standards change, you need a system that can evolve with your complex needs and a team who knows how to make it happen. The Invidasys team makes it easy, and strives to assist your organization in leveraging your existing technology investments.

We have unparalleled knowledge of healthcare, information technology, process management and implementation methodologies. This provides you with access to best practices and optimization every step of the way.

“The reality of our industry is that software is never done. Software should continue to evolve at the speed of business change. Software needs to keep up with the business. It must be an accelerant not an impediment.”

- Sherwood Chapman, Chief Executive Officer

Let's Talk about Your Needs and Invidasys can help.