SANTRAX® PAYER MANAGEMENT

Maximizing the value of every in-home encounter by ensuring proper care delivery

Leverages the integration of the plan-of-care, authorizations, eligible participants, and home care provider agencies to drive network transparency and improve care monitoring. Reduces Fraud, Waste and Abuse by only allowing claims to be submitted that meet all program validation requirements.

 

Electronic Visit Verification™

Our powerful combination of patented solutions for visit verification is called our Assured Coverage™ program and includes:

  • Telephonic Visit Verification™ (TVV™) –TVV™ uses Automatic Number Identification (ANI) technology to validate telephone calls to log in and log out, recording time and location in real-time.
  • Mobile Visit Verification™ (MVV) – Real-time GPS technology, verifying caregiver location and visits via GPS enabled devices (mobile phones and tablets).
  • Fixed Visit Verification™ (FVV™) – Patented technology to verify visits when no landline or cellular service is available.

 

Claims Validation

  • Immediate, real-time verification of authorized services including documentation of caregiver identity, start and end of each visit, location of service delivery and the creation of an electronic claim.
  • Claims engine ensures ONLY claims that match the authorization are sent to the payer for adjudication; placing the burden on the provider to bill correctly the first time.
  • Claims engine can be applied prior to claims submittal or integrated with the payer system as part of the claims adjudication process prior to payment.

Jurisdictional View/ Business Intelligence

  • Payers and the home care network share a real-time composite view of authorized LTSS within their jurisdiction.
  • Supports program transparency and tightens audit controls by providing access to home care services data to effectively audit providers and conduct extensive post payment reviews on aberrant claims.
  • Plan-of-Care and Point-of-Care data collection and reporting capabilities to efficiently and effectively collect quality metrics for community based LTSS.
  • Business Intelligence and dashboard capabilities allow you to drill down to a more detailed level, create ad hoc reports, measure performance against benchmarks and provide additional project evaluation analytics.