Leading the extensive list of enhancements is a new Appeals Module that enables users to log and annotate appeals and complaints directly in the Enterprise System. Related documentation can be attached directly to the relevant appeal or complaint record. The Appeals Module can also be used to assign which appeals specialist will work on particular appeals and complaints. As a result, the Enterprise System can create a work list for each individual showing open appeals. The system is easily searchable, and a built-in reporting function allows managers to view an overall picture or drill down into more details as needed.
"Health payers today are facing a double-edged sword of rising member expectations, due to the consumerization of healthcare, coupled with an economy that requires them to do more with less," said Darrin Haehle, chief information officer and president of Wonderbox Technologies. "Inefficient processes simply won't suffice in this environment. Wonderbox Technologies is always looking for opportunities to provide automated solutions to address industry needs. It's all part of our commitment to anticipate requirements rather than react to them."
Version 6.2 also introduces a new Therapy Portal that enables occupational, physical, and speech therapists to submit and manage requests for authorizations online rather than calling, faxing, or mailing information, which then needs to be manually entered into the system. When online authorizations are submitted through the Therapy Portal, benefit administrators and payers can immediately access the authorizations through the Enterprise System user interface. In addition, therapists can instantly view the status of all requests in the Therapy Portal, select approved authorizations, and submit claims against them with just a few clicks.
The Credentialing Application Portal has added three more capabilities to existing functionality for Payers. The first is an option to download and import an XML version of a provider's credentialing application directly into the payer's previously enabled system. This is in addition to the traditional PDF download option. For current Enterprise System users, Version 6.2 adds web service integration to pull provider credentialing data from the portal directly into the Credentialing Module with a single click, without the need for further integration. Additionally, payers will be able to view a complete download history while gaining access to individual applications for record keeping and historical upkeep purposes.
A fourth major enhancement is a provider data locking feature that prevents overwriting of the most current, verified provider information during network loads or other maintenance operations. To ensure the integrity of verified provider data, the ability to update locked records is strictly controlled through role-based security credentials, allowing the Enterprise System to be the single source of truth for provider information.
"Each new version of the Enterprise system comes with a host of new features and capabilities, and Version 6.2 continues that commitment," said Craig Kasten, chairman of the board and co-founder of SKYGEN USA. "We believe that in order to make it to the 22nd century, payers must become cyber benefit organizations in the 21st. Everything we do is based on helping them achieve that goal. The Enterprise System is already the most agile and innovative technology in the industry. Version 6.2 helps us extend that lead."
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About Wonderbox Technologies
Wonderbox Technologies, part of the SKYGEN USA family of companies that specialize in benefit management solutions, is a distinguished, agile software company focused on building next-generation technology for the specialty payer market. This technology enables healthcare payers to remain at the forefront of benefit management by using one of the world's most innovative and flexible technology platforms to dramatically improve automation, achieve compliance and reduce the cost of delivering healthcare benefits. To learn more, visit www.wonderboxtech.com.
About SKYGEN USA
SKYGEN USA is a collection of benefit solution companies that brings together a distinguished mix of next-generation benefit management and technology tools for healthcare organizations. Business units under the SKYGEN USA brand include Wonderbox Technologies, Scion Dental, Vestica Healthcare, American Therapy Administrators, and Ocular Benefits, all of which are recognized leaders in their market niches. The joining of these respected organizations under the SKYGEN USA umbrella enables them to drive process improvements and dramatically reduce the cost of delivering benefits in an advancing healthcare economy. Payers may select the comprehensive solution or individual offerings to fit their requirements. For more information, please go to www.skygenusa.com.
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