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  • Quality Solutions

    Change Healthcare offers decades of experience meeting Medicaid, Medicare, and commercial plan quality needs. Customizable and integratable offerings facilitate superior quality performance improvement.
    • View Our Quality Solutions

      Change Healthcare Quality Solutions offers proactive insights for health plans and providers to effectively manage quality program needs. Our suite of innovative services and leading edge solutions fully support HEDIS, Medicare Advantage Star Program, as well as state-specific programs. Each member of our clinical review team specializes in a specific number of measures, assuring accuracy and subject matter expertise.

      Our analysts are well adept in quality performance and take a transparent approach in working with our clients through collaboration, helping ensure complete and accurate rates.

      • Utilization and Care Analytics  
      • Gap Closure for Score Improvement 
      • Data Ingestion and Enrichment 

       

      Learn More At Altegra Health,
      a Change Healthcare company
  • Payment Integrity Solutions

    A complete suite of healthcare payment integrity solutions designed to prevent improper payments and fraud, waste and abuse at every stage of the claim lifecycle
    • Coding Advisor

      Analytics and education improve provider billing practices

      Coding Advisor utilizes multi-payer analytics and provider education to prevent fraud, waste, and abuse by addressing losses to low-dollar, high-volume claims. Our proven sequenced process benchmarks provider billing, educates providers on the most appropriate practices, and monitors changes in future billing to reduce costs from inappropriate billing of Evaluation and Management codes. Cost-avoidance savings are achieved through more accurate billing, immediately and in the future.

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    • Integrated Repricing Network

      Single-source repricing and out-of-network claims management

      Change Healthcare Integrated Repricing Network is the single source for your comprehensive integrated repricing strategy. Our proprietary routing engine, with over 70 PPO connections, can route and manage your out-of-network claims nationwide and eliminate the need for multiple direct contracts. Our experienced staff can help optimize fee negotiations and automate your Medicare base pricing process. We use multiple data sets to establish baseline pricing, so you can get the most appropriate rate.

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    • Payment Accuracy Insight

      Sophisticated analytics help prevent overpayments

      Payment Accuracy Insight uses industry expertise, combined with traditional methodologies and analytics, to identify billing and coding aberrancies in submitted claims. Our multipayer data set enables the broadest view of billing activity to help identify improper claims. We specialize in helping prevent unnecessary losses to these claims before they are paid.

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    • Audit & Recovery

      Outsourced services to recover losses from inappropriate payments
       

      Audit and Recovery services help you maximize savings by identifying and recovering lost dollars due to improper payments. Our experienced team provides a fully outsourced solution, identifying inaccurate repricing, improper coding, and misapplied reimbursements, and recovering overpayments. We specialize in DRG, HCA, CCA and RXI audits and our solutions are designed to complement your infrastructure and integrate into your existing workflow.

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  • Engagement Solutions

    Our health engagement solutions improve health outcomes, risk scores, quality ratings, and member retention while decreasing costs of care to both members and health plans.
    • Member Correspondence Advocate

      Printed, telephonic, and electronic member correspondence

      Change Healthcare Member Correspondence Advocate is the smart way for health plans and administrators to maximize member engagement through printed, telephonic (IVR), and electronic correspondence. It offers color and electronic EOBs, customized ID cards, and welcome kits that transform legacy communications and create a more meaningful member experience.

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    • Government Program Member Engagement

      Drive risk scores, quality ratings and dual enrollment
    • Omni-channel Communications

      Maximize outreach & address community programs
    • True View Health Shopping

      Simple, smart health shopping

      True View guides your members to shop and save on health services and prescriptions while comparing price, quality, providers, and nearby locations. More than just an easy-to-use platform, True View integrates seamlessly with other wellness tools and incentive programs in one connected hub—making the experience easier for everyone. As your members shop and save, your organization saves too.

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    • SSI Advocate

      SSI enrollment through predictive modeling and outreach

      Change Healthcare works on behalf of members, helping them receive valuable benefits at no cost to them. Working directly with Medicaid Managed Care payers, we use predictive modeling for candidate screening. We assist candidates through the application process as their authorized representative. Change Healthcare also works closely with case managers to obtain referrals for high-risk members, who can often be expedited through the approval process.

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  • Payment Solutions

    Electronic payment options, for consumers and providers including claim settlements, premium payments and consolidated printing that lowers administrative costs and encourages electronic adoption.
    • Member Payment Advocate

      Member-friendly ways to bill and collect premium payments

      Member Payment Advocate is the member-friendly consumer payment solution that makes it easy for health plans to bill and collect premium payments. It deposits payments into the appropriate accounts and posts consumer payment information to streamline your workflow, while mobile, online, IVR, lockbox, in-person and agent-assisted payment options improve consumer choice and satisfaction.

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    • Payment Network Advocate

      Electronic healthcare payment solutions and consolidated printing

      Payment Network Advocate is the industry-leading healthcare payments network - minimizing payment distribution costs through the broadest array of payment options in a single platform. Our preference-based payment analytics determine the most cost-effective payment distribution method across a network of over 600,000 providers. Payment Network Advocate also reduces print and mail costs by consolidating printing and correspondence.

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    • Settlement Advocate

      Consolidate payment, reconciliation, and 1099 processes

      Change Healthcare Settlement Advocate is the settlement solution that consolidates draw down, reconciliation, and IRS 1099 processes for all payment types in a single platform while driving electronic payment adoption. Increased use of electronic payment methods drives cost savings, reduces workloads, and improves service levels.

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  • Risk Adjustment Solutions

    Data submission, risk model management, risk score trending, risk gap analytics, member and provider targeting, risk adjustment project management, chart retrieval and coding, risk adjustment financials, risk adjustment audits, and provider education.
    • Change Healthcare Risk Adjustment Solutions

      Change Healthcare Risk Adjustment Solutions combine leading edge technology with ongoing analysis and expertise to optimize risk adjustment and encounter reporting. Through our proprietary services, we enable healthcare organizations to submit accurate and timely data and improve revenue and quality of care in an efficient, proactive, and compliant manner. Our Risk Adjustment Solutions provide comprehensive data submission to regulatory entities; continuous monitoring of risk adjustment factor (RAF) score gaps and the ability to prioritize resources used for risk adjustment activities.  Our advanced analytics and risk adjustment expertise interpret risk score trend data to create sound prospective and retrospective risk adjustment strategies.

      • ACA-Commercial
      • Medicare
      • Managed Medicaid

       

      Learn More At Altegra Health,
      a Change Healthcare company
  • Network Solutions

    Enhanced automation and edit capabilities drive efficiency and cost savings throughout the claims adjudication process. Comprehensive network connectivity provides unparalleled insights into your business.
    • Eligibility and Benefits Verification Network

      Delivers electronic benefit eligibility information

      The Eligibility and Benefits Verification Network allows providers to access real-time eligibility and benefits information. Transparency around benefit information for each patient allows providers to determine if the patient is eligible for the service being considered and that necessary information is available and accurate. Taking these steps at the point of service ensures that appropriate payments will be made and received by all parties. Real-time transactions are accessed with either a direct or hosted connection.

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    • Claims and Remittance Network

      Electronic transmission of claims and remittance processing

      Receive electronic claims processing and remittance advice through our extensive intelligent network. Claims are securely transmitted in HIPAA-compliant formats from provider to payer for receipt and payment. Automation is streamlined with advanced edits that help ensure accuracy and reduce costs. Our nationwide electronic network reach allows us to connect to any system for all payer-to-provider HIPAA-mandated transactions.

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    • Referrals and Authorization Network

      Automated referral and authorization transactions

      Our Referral and Authorization Network facilitates automated referral and authorization transactions and communication to the benefits workflow, allowing providers to confirm the authorization of service directly. Streamlining these transactions can help to reduce operational burden and costs. The healthcare services review transaction includes prior authorization, specialty care, advance notification and referral.

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  • Consulting

    We partner with our clients to chart a path forward in the complex maze of today’s healthcare environment by focusing on enabling smarter business decisions to help you anticipate and navigate changes.
    • Retail Transformation

      Expert strategic consulting services

      With consumers bearing an ever-increasing portion of their healthcare costs and navigating more choices than ever, innovative health plans and providers have recognized the need to place the consumer at the center of their business model. Change Healthcare Consulting helps health plans and healthcare providers define and execute strategies that will position them for success in growing retail insurance markets.

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    • Business Transformation & Optimization

      Complete enterprise transformation

      Change Healthcare Consulting helps health plans modernize their infrastructure and transform their operations into nimble, efficient enterprises that can respond to ever-changing market demands. Leveraging modern technology solutions and redesigned business processes, health plans can become more cost-effective, consumer-centric, and provider-friendly. Change Healthcare consultants have the expertise and tools to help you capture opportunities from change.

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    • Government

      Expert consulting services

      Government-sponsored insurance markets represent a significant growth opportunity for many health plans. Success, in this area, requires dedicated focus and a broad understanding of relevant regulatory requirements. Our consultants, who specialize in the government-sponsored insurance market, offer our clients insights gained from experiences ranging from supporting CMS with audit protocol development to operating in executive level positions in Medicare and Medicaid Plans.

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    • Compliance

      Expert consulting services

      Change Healthcare is uniquely positioned to help you achieve a culture of compliance by providing regulatory gap assessment and remediation services. It will bring peace of mind from knowing your organization is doing the right thing and is prepared to pass audit scrutiny. Our compliance experts have worked with CMS to help develop CMS audit programs, and have real world experience in health plan administration.

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    • Population Health

      Improve outcomes for patient populations

      Effective population health programs deploy a strategic and comprehensive approach to population health management that contemplates the organizational structures, roles, responsibilities, incentives, processes, underlying technologies, and digital tools needed to unleash the value. Our consultants have the clinical, operational, and system expertise necessary to work side-by-side with you to chart a clear path through this evolving landscape.

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  • Dental Network

    Dental Network solutions empower payers to realize significant cost savings through a comprehensive suite of revenue cycle solutions that automate adjudication workflows and drive EDI utilization.
    • Real-Time Claim Status & Eligibility & Benefits Verification

      Automate the eligibility verification process

      With our Claim Status and Verification solution, your providers can access real-time information, giving transparency around benefit information for each patient allows providers to determine if the patient is eligible for the service being considered and that necessary information is available and accurate. Taking these steps at the point of service ensures that appropriate payments will be made and received by all parties. Real-time transactions are accessed with either a direct or hosted connection.

    • Electronic Claims Processing

      Reduce costs of paper-based adjudication processes

      Receive electronic claims processing through our extensive intelligent network. Claims are securely transmitted in HIPAA-compliant formats from provider to payer for receipt and payment. Automation is streamlined to help ensure accuracy and reduce costs.

    • Dental Connect

      Help reduce costs by driving provider use of electronic transactions

      Dental Connect is an intuitive, web-based portal that streamlines electronic claims submission and payment processes. Features include eligibility verification, rejections and denials management, dental attachments, ERA management, and electronic funds transfer. Payers can white-label the portal, and some choose to subsidize the cost for their providers, which helps drive utilization. Dental Connect also helps improve payer-provider engagement.

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    • Dental Claim Attachments

      Help save money by switching to electronic attachments

      Change Healthcare Dental Claim Attachments is designed to yield time and cost savings for both providers and payers. Payers gain efficiencies with our electronic solution and we only charge for the attachments they view.

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    • Electronic Remittance Advice

      Simplify electronic remittance advice processes

      Automate the electronic remittance advice with our intelligent system to provide quick and streamlined information. Equip your providers with a consistent and easy-to-understand format you can quickly search, view or print each remittance as needed.