Claims Fraud & Abuse
The size of the health care sector and the enormous volume of money involved make it an attractive fraud target. Therefore, effective fraud detection is important for health care payers to reduce the cost of services. HTC’s solution proactively identifies potentially fraudulent claims through the use of proven techniques and isolates them for further investigations and inquiries.
Cost Trend Analysis
Advancements in medicine and technology have lengthened the lives of Americans, but they do not come without a cost. Rising health care costs raise health insurance premiums and make it more difficult to purchase insurance policies, which contribute to the rise in the number of uninsured. At HTC, we predict cost trend analysis where we take claim invoice amount from the providers for the past years as input and output is the forecasts for future months.
Enterprise Data Hubs
A common challenge among most of the payer organizations is the lack of a centralized data repository to consolidate data from different systems with different formats of data from multiple upstream functional areas. Reporting cycles and dashboards can also be delayed, in turn impacting critical business decision making. HTC has addressed this challenge by developing the ‘Enterprise Data Hubs’ model, which will seamlessly consolidate data from disparate systems, reduce reporting cycle times and enable effective information exchange across the organization and beyond.
Many a times when the cost shifts to the patient’s responsibility, providers find it difficult in determining the patient amounts. Provider Payment Estimator can help providers to reduce the administrative costs and save time by offering providers more self-service functionality in determining patient coverage. HTC’s Provider Payment Estimator is an extremely intelligent online tool that enables providers determines patient eligibility and a more accurate estimate of the patient responsibility amount, prior to rendering the medical service.
There are a large number of providers offering Health Savings Accounts but the biggest question that remains as a mystery is “how much?” to invest on Health Savings Account. Understanding this need, HTC’s HSA estimator tool will educate your members on the cost of each healthcare service they plan to obtain, to enable making well informed decisions on the amount to be allocated for each health need.
ICD10 Solution Framework
ICD10 migration tools and products promise comprehensive impact analysis and determinate crosswalks. Such products are generic, expensive and require significant additional work to customize it to your organization.
We at HTC understand that there is no one size that fits all and each organization has a unique approach to the mandate. Our services are based on our deep understanding of the Payer industry. We recognize that over 80% of the ICD9 diagnosis codes cannot be mapped to a single ICD10 diagnosis code unless supporting clinical data is available. Determining the closest map also requires assessing codes for Payment and Clinical equivalence and every Payer differs in their assessment approach. We also understand that the ICD10 mandate is one of the many top initiatives you are trying to balance. HTC’s ICD10 Conversion and Testing Framework helps expedite and complete the conversion effort.
The United States, with over 321 million mobile subscribers, has the third-largest mobile phone users in the world. Mobile applications are enhancing the overall consumer engagement in healthcare by increasing the flow of information, lowering costs through better decision-making, making fewer in-person visits and greater adherence to treatment plans, and improving satisfaction with the service experience. Mobile solutions hold tremendous potential for changing the way we obtain healthcare today.
Increasing penetration of smart phones and consumer adaptability to smart devices has enabled mobile phones to play an important role in healthcare. Delivering relevant and enriched services have also become easier.
HTC’s mobile healthcare solutions enable healthcare organizations to create a new model for healthcare access, payment, and delivery.
HTC has been developing tools to increase patient engagement. Customized mobile based appointment alerts, education on preventive measures, and post-operative care support will help your organization to engage patients in their health outcomes and reduce overall cost. Patients can have access to their Medical records, their allergies, history, current prescriptions etc., on their mobile.
In the preventive health and wellness space, HTC offers wellness, exercise, smoking cessation and nutrition apps especially for patients with chronic conditions such as diabetes and high blood pressure.
Alerts for vaccination, immunization, pre-natal and post-natal care through mobile will not only enable preventive health but also ensure customer loyalty and good will. The medication reminder provides timely, self-directed and secure messaging reminders that help patients take their medication on time. Healthcare provider search features on the mobile allow patients to locate physicians, pharmacies, and hospitals even on the move or during emergencies.