Today’s Challenges in Fighting Errors in Automated Medical Apps


According to several market studies, about 7% of HEDIS tasks could not be properly processed due to coding-related issues. Moreover, industry professionals indicate that this problem will only aggravate following the eventual transition to ICD-10 in future.

Generally speaking, claims data may play tricks if not managed as it should. For instance, the claims of a particular plan may contain inaccuracies in the full history section of a client. This may happen as a result of the lack of previous procedures or conditions’ record in the claims data. Besides, it’s not always the case when providers code an encounter which allows members to get credit for that.

Processing Supplemental Data

National Committee for Quality Assurance (or NCQA) permits plans to collect supplemental data for HEDIS reporting. Check out General Guideline 39 from NCQA to have a look at requirements for processing such type of data. Nowadays, to gather supplemental data, the variety of metrics such as medical records retrieval service or site visits are used. The problem with such methodology is that it turns into a tedious and, what’s worse, quite expensive process.

The modern technology is all about automation no matter what industry you’re in. Existing solutions smoothly coordinates the sophisticated way plans and their providers interact, and this solves the problem of time-consuming tasks and economizes funds. And here’s where the Virtual Blueprint Analysis which gathers supplemental data following the requirements of NCQA and CMS comes real handy. The solution tracks each and every task at any given phase of the process, so one doesn’t have to worry about audit issues.

The system of Virtual Blueprint Analysis belongs to the Supporting Data Module. In turn, the module uses reliable medical solutions by Elinext, the SaaS platform the company developed. The reach functional of the software allows its customers to manage interactions with their providers on HEDIS metrics.

First, the solution takes care of importing HEDIS metrics by both provider/member sections from a current reporting system of a client.  Then the platform finds inconsistencies in care for each provider, allowing them to access visually-appealing reports and tools by the member.

Thanks to the solution, you no longer have to rely on complicated reports to contact providers as the system itself turns every open care metric into a separate task. The only condition is that tasks should be granular.

This peculiarity of the workflow saves an enormous amount of time. Users can get any type of information they need without looking at a whole medical record, and any task represents a specific patient and procedure.

It’s time to make your providers act proactively

Besides being granular, the tasks of providers on their activities (which drive your HEDIS metrics) have to be actionable too. This way, you can get timely feedback on any task in an enclosed loop process. The providers provided with the possibility to submit the required documents in a secure way will deal with the variety of possible gaps in a convenient way. It’s worth noting that this newly-acquired data goes directly into your HEDIS reporting system.

The right solution to engage your providers

Our platform is a perfect match when it comes to managing risk and compliance tasks for numerous groups of independent parties such as provider networks. Since the solution automates daily routine tasks, it is possible to concentrate your efforts on proactively dealing with various issues.

The approach that our platform offers is ICD-10-friendly and secure so that providers have easy access to any information they may need. Besides, one of the greatest features of the platform is the possibility to process feedback from providers which has a positive effect on getting a higher mark in the rating system. The Supporting Data Module can also be extended into a full Star Rating or P4P program management platform.

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