Episode Manager

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

Scale Your Prospective Bundled Payment Program

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.

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.

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

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

Streamline Prospective Payment Processes

Automate prospective bundled 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.

Configurable episode of care 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.

Episode based 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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