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Points of Light 2023 Case Study 3
Enabling Bidirectional Data Sharing to Reduce Record Requests for Managed Care Audits
Author
Boyd Stewart
Author
Aurene Wilford
To meet CMS requirements for the submission of risk adjustment data and ensure they are being fully reimbursed by CMS, payer organizations need increasingly specific coding information, and these requests for information can put undo administrative burdens on provider organizations. Seeking to increase the payer organization’s access to needed information without increasing the provider organization’s workload, the collaborators in this case study established an API that enables an automated, standardized retrieval process for records that the payer organization needs in order to complete managed care audits.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Elizabeth Pew
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.