Current EDPS submission solution was not very robust or stable. No easy way to upgrade as each customer was on their own build.
No visibility into the rejection rates, submission rates or error reasons.
Needed a solution that allowed them to edit without going back into their core claims system and manage the process better.
Submissions were close to two years behind … needed to clean up and catch up.
Client chose Babel Health because of the key understanding that a better way was needed to edit encounters without having to update the core claims system.
Eligibility, claims and provider operational teams can now access error correction directly.
Able to staff appropriately based on the new visibility. Learned that they needed one additional Level 1 analyst versus another senior analyst necessary with former vendor.
Submission and error rates have improved due to the ability to remap without having to request new builds.
Rely on a fully managed SaaS/cloud environment on AWS, allowing dynamic scale, business continuity, CMS-approved security, and HIPAA compliance.
Biggest highlight: working with a knowledgeable team that is far superior to what they dealt with previously.
New England Health Plan
Legacy EDPS/RAPS submission solution did not allow for any control over the submission process. The plan was wholly reliant on the vendor’s submission schedules and reporting capabilities.
Could not perform ad hoc or batch error correction without extensive technical efforts to modify data transformations from the core adjudication system.
Needed a solution that would minimize internal IT support requirements so those assets could be refocused on other strategic projects.
Client’s submission rates were dramatically improved — from 62% to over 98%.
The overall burden on the IT group was reduced as was the error correction effort.
Preliminary estimates on the long-term implications for both error correction and retrospective correction of encounter data suggest the client had an estimated $6 million in revenue at risk if the submission improvements not been made.