Consumer Driven Health Plans

Consumer Driven Health Plans (CDHP) and their related entities such as third party administrators, clearinghouses, and health information exchanges are witnessing various trends and changes across CDHP.

Some common trends observed across CDHP:

• Flexible consumer health plans with lower premium and high deductibles
• Control over healthcare choices, providers selection, and managing their own health expenses
• Changing regulations such as HIPAA 5010 and ICD-10
• Increasing number of employers turning towards CDHP with a hope of controlling costs without cutting benefits and/or raising contributions
• Improved web portals for members and employers  to access health plans and to choose providers

emids, by the virtue of its domain expertise, understands various processes and systems across consumer driven health plans. We also understand various CDHP such as:

• Flexible Spending Account (FSA)
• Health Reimbursement Arrangement (HRA)
• Medical Savings Account (MSA)
• High Deductible Health Plan (HDHP)

Services

• Application management services and QA & testing
  emids provides application maintenance and support, system modernization and migration, and enterprise application integration services coupled with our QA & testing services to CDHP such as FSA, MSA, HDHP, HRA specific applications, provider contracting rules engine, employee benefits application, employer portals and claims management applications
• Consulting
  emids provides HIPAA 5010 and ICD 10 readiness assessment, and solution design and establishing new technology strategies as part of consulting services to FSA, MSA, HDHP, HRA plans
• BPO
  emids' BPO services for CDHP include payment analysis of CDHP claims, CDHP member and provider enrollment, CDHP claims administration, CMS validation and CDHP provider license verification. The services provided are coupled with our automation solutions to improve productivity, reduce turn-around time and manual intervention

Solutions

• HIPAA 5010 transition and business testing
  emids provides HIPAA 4010 to 5010 transition and business testing solution to FSA, MSA, HDHP, HRA plans and their applications. The solution is classified into: impact assessment services, remediation planning and implementation and HIPAA 5010 testing services includes independent testing and validation. emids HIPAA business testing framework can help entities in different areas including gateways testing, claim systems testing, trading partners testing and validation edits
• ICD-10 transition
  emids' ICD-10 transition solution can assist CDHP and their applications to adapt new coding standards. emids' streamlined transition solution include: consulting and impact assessment services, remediation, planning and assessment, and ICD 10 testing services
• Claims management
  emids' expertise around FSA, MSA, HDHP, HRA, enables to understand and process CDHP claims, analyze overpayment made by the plans and automate the QA process. However, the claims management solution is classified under consulting, technology and operations
• BI and analytics
  emids understands the FSA, MSA, HDHP, HRA information systems, and their processes and business.  Our BI and Analytics solution for CDHP ranges from claims data analysis to Extraction, Transform & Loading (ETL) process of data from FSA, MSA, HDHP, HRA, third party administrators, and revenue cycle management companies
• Interoperability
  emids can help FSA, MSA, HDHP and HRA to achieve the interoperable standards with perfection. This is enabled by our in-depth knowledge of interoperable standards such as HL7, DICOM, HIPAA, ICD, IHE, LOINC, SNOMED and NCPDP SCRIPT. Our interoperability solution is lined along consulting, developing and testing, maintenance and support, and training
• Mobility
  emids' domain and technology expertise enable us to develop mobile applications for FSA, MSA, HDHP, HRA plans. Our mobile application development services span across Apple iPhones, Google Android and Blackberry

Benefits

• Specialized healthcare knowledge resources for implementing standards for compliance like meaningful use, HEDIS reporting, HIPAA EDI, ICD-10
• Automation in FSA, MSA, HDHP and HRA plans, processes and systems
• Integration with healthcare exchanges and enterprise systems
• Easier adoption of newer technology, leading to better patient experience
• Our tools, templates and processes accelerate the production cycle
• Readily available test scripts for varied healthcare workflows which quickens turnaround time
• Our in-depth understanding of data models and tools accelerates the development process

Case studies

• Development and QA of PoE application for a leading payer
• Implementation of auto adjudication tool for a leading payer
• PeopleSoft financials implementation and integration with an HR product for one of the largest Medicare Advantage plan
• Technology migration of claim administration product for a leading payer
• Build, test, and operate an automated erroneous claims detection system for a US top-3 insurance processor
• Migration of client data from legacy systems to new workflow-based disease management clinical platform

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