With multiple payors and contracts to manage, it’s not surprising that the healthcare revenue cycle is losing millions each year because of oversights, errors and inefficiencies in their payor administration process. Pathways Contract Management™ automates the contracting and reimbursement process, including monitoring payor payments to improve claim denial management, updating accounts receivable and performing what-if contract modeling analyses across all payors to strengthen contract negotiations. The contract and claims information also enables you to estimate patient out-of-pocket healthcare costs during registration to increase point-of-service collections.

Benefits

• Increase cash flow by enhancing reimbursement monitoring and collection capabilities
• Improve point-of-service collections and respond to healthcare price transparency requirements
• Enhance efficiency of managing multiple payor contracts, including specific terms and conditions
• Streamline reimbursement calculations by accumulating reimbursement statistics by payor at the claim and contract level
• Boost revenue recovery by efficiently identifying, tracking and managing denied claims
• Improve processes and monitor payors based on executive reports
• Reduce collection timeframes by working within your receivables management system to prioritize recovery efforts and track appeal status

Features

• Provides claim denial management via a centralized repository of denial information, making the necessary claim detail readily available to support communication with payors during the recovery process
• Price estimation assistant leverages contract and claim history to produces price estimates
• Interface to virtually any patient accounting system
• Denial and appeal analysis improves contract management by highlighting reimbursement discrepancies