- 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.