Healthcare Insurance: Change Explained

Change Healthcare is a healthcare technology provider that offers revenue cycle management, payment management, and health information exchange (HIE) solutions. The company creates products and services for payers, providers, and patients within the U.S. healthcare system. Change Healthcare aims to improve clinical and financial outcomes and enhance the overall healthcare experience. Their advanced technology and services help providers enhance patient engagement and access, improve outcomes, drive revenue performance, and optimise operational efficiency.

Change Healthcare's insurance verification software

Change Healthcare is a healthcare technology provider of revenue cycle management, payment management, and health information exchange (HIE) solutions. The company's insurance verification software, Coverage Insight™, is an analytics-driven tool that helps providers identify undisclosed coverage for patients presenting as self-pay or underinsured. This software is designed to help providers achieve accurate revenue by detecting undisclosed reimbursement sources within 2-24 hours.

The software uses advanced data mining, machine learning algorithms, predictive analytics, and an expansive network of payers to identify existing insurance coverage. It helps verify data accuracy by confirming a patient's benefits and the applicability of all discovered information. Irrelevant information is suppressed by screening the byproduct of self-pay and eligibility processes to determine which information has been historically useful.

The company's platform provides industry-leading analytics, expansive data, and unparalleled connection and data transfer between providers, payers, and consumers. Change Healthcare aims to improve workflows, increase administrative and financial efficiencies, and enhance clinical decisions. Their solutions include network solutions, software and data analytics, and technology-enabled services.

Change Healthcare's revenue cycle management

Change Healthcare is a large, independent healthcare technology company that works with customers and partners to enable better patient care, choice, and outcomes at scale. The company provides software and analytics, network solutions, and technology-enabled services for government payers, employers, hospitals, physicians, and others.

Revenue cycle management (RCM) is the financial process healthcare facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. It involves identifying, managing, and collecting patient service revenue. RCM begins when a patient schedules an appointment and ends when the organisation has collected all payments from the patient and/or their insurer.

RCM is essential for healthcare organisations to maintain financial stability and provide quality patient care. It helps strengthen revenue by minimising claim denials, reducing days in accounts receivable, and increasing collections. It also helps healthcare providers receive correct and timely payments and optimise financial performance.

The revenue cycle includes all administrative and clinical functions that contribute to capturing, managing, and collecting patient service revenue. The following activities are involved in the revenue cycle:

• Charge capture
• Claim submission
• Coding
• Patient collections
• Preregistration
• Registration
• Remittance processing
• Third-party follow-up
• Utilisation review

RCM systems are essential for storing and managing patients' billing records, which are crucial for efficient and error-free revenue cycle management. These systems can be standalone or integrated with electronic health record (EHR) systems. They help reduce the time between providing a service and receiving payment and can automate duties such as administrative tasks, appointment reminders, and balance notifications.

RCM systems can also provide insights into why claims have been denied, prompt healthcare employees to enter all the information required for claims processing, and minimise the probability of denied claims. They may also incorporate data analytics capabilities and provide dashboards to monitor revenue goals.

RCM is crucial for healthcare organisations to adapt to the transition from fee-for-service to value-based reimbursement and care models. RCM systems provide analytics that enable organisations to assess their patient population, monitor claims data, and pinpoint abnormalities. They can also provide reports about healthcare costs and patient satisfaction to insurers, increasing the chances of receiving full reimbursement and minimising claim denials.

Change Healthcare's payment management

Change Healthcare is a healthcare technology provider that offers revenue and payment cycle management solutions. The company's payment management services aim to streamline the payment process for healthcare providers, improving efficiency and accuracy while reducing costs.

Flexible and Efficient Payment Solutions

Change Healthcare offers flexible and efficient payment solutions to providers, connecting them to over 600,000 other providers. This extensive network enables providers to streamline reimbursement and optimize claim processing. By increasing the adoption of electronic payments, Change Healthcare helps to reduce administrative costs and streamline payment workflows.

Payment Automation

Change Healthcare's payment automation solutions enable providers to integrate key processing functions into a single platform, improving accuracy and efficiency. Their technology helps convert paper remittances into digital files, reducing manual effort and accelerating cash application. The automation of payment and remittance processes also eliminates potential human errors and improves revenue cycle accuracy.

Analytics-Driven Claims and Remittance Management

Change Healthcare provides analytics-driven claims and remittance management tools that help financial managers efficiently handle all types of payer claims. This includes commercial, Medicare, Medicaid, and Worker's Compensation claims. By offering ongoing claim visibility and proactive follow-up, Change Healthcare helps accelerate claim payment, limit denials, and improve resource utilization.

Patient Payment Solutions

Change Healthcare offers patient payment solutions that accelerate patient payment collection and improve the overall patient financial experience. These solutions provide flexible payment options, such as online and automated phone payments, and seamless integration with patient portals. This enables providers to securely transmit card payments and improve the speed and convenience of patient payments.

Provider Payment Management

Change Healthcare's provider payment management solutions focus on simplifying provider payment settlements. By consolidating payments and reconciliation across all payment types into a single system, payers can eliminate unnecessary costs and streamline the settlement process. This solution also encourages electronic payment adoption, reducing print payment-related costs.

Change Healthcare's health information exchange

Change Healthcare is a healthcare technology provider that offers revenue cycle management, payment management, and health information exchange (HIE) solutions. The company's HIE platform enables the secure and seamless sharing of patient medical information between healthcare organizations, such as hospitals, clinics, laboratories, and physicians' offices. This facilitates collaboration and communication among different healthcare providers, resulting in improved patient-centric care.

The HIE platform offers several benefits to healthcare providers and patients. It streamlines administrative tasks, reduces paperwork and storage costs, and enhances care coordination. Providers can access a patient's comprehensive medical history, including diagnoses, medications, allergies, and lab results, enabling informed decision-making and avoiding duplicative tests. The platform also improves medication management, streamlines the referral process, and enhances patient satisfaction.

Change Healthcare's HIE platform ensures the secure exchange of health information by employing strong encryption protocols, role-based access controls, multi-factor authentication, and audit trails. The platform adheres to stringent privacy regulations, such as HIPAA, to protect patient confidentiality and ensure compliance.

The company's advanced technology and services help providers enhance patient engagement and access, improve outcomes, drive revenue performance, and optimize financial and operational efficiency. Change Healthcare is committed to improving the healthcare journey and empowering partners to achieve their strategic business objectives.

Change Healthcare's network solutions

The company's clinical interoperability solutions aim to maximize inter-office communications and eliminate delays, costs, and errors caused by manual retrieval and transmission of healthcare documents. Their electronic prescription application, for example, securely connects providers directly to pharmacies for fast and reliable prescription generation and routing, improving patient safety and saving time.

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