Blue Line: Predictive #Analytics for #Healthcare

Congress through the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the creation of the 835 EDI Remittance Advice, not only to establish a standard to facilitate and promote EDI for payments, improving efficiency, productivity and reducing administrative cost but more importantly by requiring detailed clinical information including providers, procedures and diagnosis to be included in the 835 RA, Medicare could collect valuable clinical information on the 1.2 billion claims processed annually. This information will be the basis for establishing quality of care standards and evidence based medicine.

835 remittance files are the only standard, common source of detailed “claim to payment information” regardless of provider, payer or system.  With most Healthcare Systems running multiple Patient Accounting Systems, that typically at best support rudimentary reporting and analytics because they are optimized for efficient claim submission and payment collection, and contract with dozens of payers any efforts to consolidate, report and analyze “claim to payment information” is cost and effort prohibitive.

Unlocking 835 remittance files is the only approach, an opportunity to provide detailed patient clinical, operational and revenue cycle analytics.

The 835 EDI remittance contains a wealth of patient clinical, patient financial and operational data not just payment information. (Many healthcare providers use the 835 EDI  only to post insurance payment information to their Patient Accounting system and are "unaware" of the detailed clinical and financial data provided in Remittance Advices.) This 835 contains details on every procedure, diagnosis and date of service in addition to payment information including payments, denials, self pay balances and payer groupings – over 100 but potentially 1000’s of individual data elements. By applying statistical models - trends, correlations and sophisticated analysis can be uncovered that is not apparent through traditional reporting. Analysis proven to reduce costs and increase reimbursements and cash flow.

Blue Line's 835 Predictive Analytics Application enables healthcare providers  to fully utilize the data available in 835 EDI files - detailed Clinical, Financial and Operational. Analyzing the data delivered in 835 files can be a vital component of a healthcare organizations' clinical, operational and revenue cycle activities. Features include:

• Prebuilt Predictive Models, leveraging statistical models and methodologies to uncover clinical, operational and reimbursement trends across millions of records not easily uncovered by traditional reporting tools
• Prebuilt Data Marts to organize and optimize the data contained in 835 Remittances for Analytics and Reporting
• Prebuilt dashboards, reports, analytics and metrics across a variety of 835 Remittance data

This crucial intelligence can provide insight into trends and affect future outcomes. Combining this analysis can have a significant impact in areas such as:

• Hospital readmission rates and Quality Reporting metrics
• Revenue Cycle Management effectiveness and proper coding for rapid claims adjudication

Contact BlueLine today at (866) 589-3440 or info@bluelineplanning.com for more information, or contact me via my IBM marketing page at www.ibm.com/myrep/jagaeta.