Operational Transparency

Solution Center
  • PDF
  • Print

Reduce administrative expense and improve provider satisfaction with Operational Transparency

Core Drivers of Value
  • Net savings of 5% to 7% of total administrative expense resulting from improved administrative efficiency
  • Up to a 4-point reduction in medical trend per hospital or physician group during recontracting

img
Examples of graphs from Operational Transparency dashboard

Solution Overview


Operational Transparency, part of MedeAnalytics’ Payer-Provider Collaboration suite, is the only solution on the market that enables health plans to reduce unnecessary denials and appeals and improve operational performance simultaneously. Payers communicate with providers via a web-based analytic portal, sharing key performance indicators—such as turnaround time, appeal and denial reasons—and enabling providers to drill down to the root causes of their underperformance.
Health plans use Operational Transparency to identify cases where medical policy is frequently overturned, errors in claims edit policies and other sources of unnecessary denials. Inclusion of processor information identifies internal training opportunities. Given that per-appeal costs range from $20 up to several hundred dollars, savings mount quickly.
Operational Transparency is delivered via a Software-as-a-Service platform, enabling rapid time-to-value with minimal IT disruption. Provider relations can begin rolling out the fully functional Operational Transparency solution within 90 days of implementation kickoff, and customers recognize value within six months of go-live.
MedeAnalytics’ Payer-Provider Collaboration suite increases provider satisfaction, eliminates administrative waste and improves quality. MedeAnalytics delivers performance management solutions across the healthcare system—including hospitals, physician practices and payers—to ensure accountability and improve financial, operational and clinical outcomes.
Quality Improvement: Opportunities for Payer-Provider Collaboration
Click to download this white paper
Learn more about Operational Transparency
Click to download the data sheet

"POET [Blue Shield of California’s name for MedeAnalytics’ Operational Transparency solution] represents a smarter way of doing business. Since hospital contracting executives can now see all the data sharing and collaborative work that happens, we no longer have as much finger-pointing over claims disputes."

- Juan Davila

SVP, Network Management

Blue Shield of California