One feature set enables providers to easily update their information through the MCO's provider web portal (PWP) in a couple of steps rather than having to send information via fax or mail. Providers receive a notification through the portal that information must be verified, then click through to review it. If the information is still valid, they can approve it with one click. If changes must be made, they can edit, make the changes, and submit the updates instantly.
The second feature set enables payers to specify which provider updates require review. For example, a change to a middle initial may be passed through, while a change to whether the provider is accepting new patients may require review. A change to any field requiring review will allow the payer to validate and accept the new or changed information prior to updating the master data record. Once the changes are approved, the system automatically re-sets the clock on the next verification.
"Rapidly changing regulations can place a huge burden on payers, who are left scrambling to try to meet these new requirements through manual means," said Darrin Haehle, chief information officer and president of Wonderbox Technologies. "We are dedicated to anticipating these market advancements and developing solutions that automate processes where they make sense, while giving payers the flexibility to make adjustments where they feel the need. The enhancements in version 6.3 reflect that commitment."
Another significant addition to version 6.3 builds on the appeals module first introduced in version 6.2. The new capability allows users to create follow-up tasks on an appeal and assign the tasks to an individual or groups. Users can filter the tasks to see only those that apply to them in order to create a to-do list, as well as look at the status of all tasks that apply to a specific open appeal to ensure everything is completed in a timely manner so the appeal can be closed faster.
Version 6.3 also introduces a new provider ranking system that payers can use to measure the performance of providers in their networks. Payers can define panels based on similarities such as geography, area of specialty, demographics of their patients, etc. to ensure providers are being measured only against others who share similar characteristics rather than all providers in the network.
Once the panels are defined, payers are able to create a customized evaluation process to measure provider performance. Payers can define the parameters to be measured and how each will be scored. Scoring can be based on a fixed scale (such as 0 to 25), or versus the performance of other providers. The individual scores are then aggregated to create the provider's overall score.
With these scores in hand, payers can then reward providers with benefits such as requiring fewer authorization approvals. They can also determine if additional training or education may be needed for providers with lower scores.
"Making the transition to a cyber benefits organization isn't optional. Payers must make that move quickly if they plan to continue in business," said Craig Kasten, chairman of the board and co-founder of SKYGEN USA. "The enhancements in Enterprise System version 6.3 help payers work more efficiently today while ensuring they are on the right track to the future."
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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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SOURCE Wonderbox Technologies