Episode Manager

A value based payment solution for payers that want to integrate prospective payment models into their existing claims workflows.

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Scale Your Prospective Payment Program

episode-management-streamline-program-administration

Streamline program administration by identifying episodes from a trigger claim within your existing claims system workflow and bundle all episode claims in near real-time.

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Integrate fee-for-service pricing by using both Episode Manager and ClaimsXten on the same technical platform, allowing for an efficient mixed model payment approach.

episode-management-configure-your-own-episode-definitions

Configure your own episode definitions or leverage Prometheus or CMS episode definitions.

episode-management-develop-managed-bundle-programs

Develop and manage bundled payment programs that help define your episodes or reevaluate your existing strategy.

Streamline Prospective Payment Processes

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Automate prospective payment processes

  • Configure our rules-based solution that works within your current claim workflow to bring automation to prospective bundled payment programs.
  • Combine clinical dashboards and claims transaction functions to help support prospective payment programs at scale, promote quality care, and help reduce administrative and medical costs.
  • Simplify the transition from retrospective to prospective payment models approach when you are ready.
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Configurable episode definitions

  • Support for multiple episode configurations and custom episode definitions.
  • Leverage Prometheus or CMS episode definitions or customize these definitions to meet your specific market needs.
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Episode payments monitoring

  • Allow episode analysts to compare program definitions to actual claim data and to recognize trends with summary and detail reports.
  • Get a clear and consistent view of key performance metrics associated with episodes from visual dashboards.
  • Help Adjudicate claims quickly and accurately to all the providers included in the episode of care.

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