Tampa, FL — Healthesystems recently deployed a major version release of its proprietary state reporting tool which includes the capability of reporting ancillary benefit management (ABM) services, such as DME and home health services. In addition, the platform enhancement provides the capability to report additional ancillary services in the future.
The Healthesystems State Reporting Tool is a proprietary application, and was designed and built by the Healthesystems software development team, in order to accommodate the many nuances and technical requirements of workers’ compensation state reporting. In 2010 the company also expanded the tool to include professional services in order to accommodate reporting of physician dispensed drugs. The new 2011 enhancement now accommodates ancillary medical services reporting functionality and allows for the submittal of both professional and institutional services. The universal reporting platform also supports the NCCI medical data call reporting requirements.
Similar to the innovative tools Healthesystems has developed for managing their workers’ compensation PBM and ABM programs, the state reporting platform is designed to process and manage transactions in a prospective manner. A series of extensive rules and edits are enforced upfront within the reporting application to proactively identify errors prior to submittal, and subsequently transmittals are validated via an electronic return acknowledgement. This pre-processing of data eliminates the administrative burden many payers face when having to clean up state reporting data.
In states where reporting performance is measured, such as Florida and Texas, Healthesystems has continually exceeded industry averages. In fact, the company has never been issued a penalty on its state reporting transactions — an accomplishment not many companies tasked with reporting can claim. In addition, Healthesystems excels in its ability to submit reporting well within each state’s timeframe — and in many cases ranks as the most timely reporting processor on record.
“One of the reasons our state reporting tool has been so successful is because internally we set extremely high standards,” stated Daryl Corr, president of Healthesystems. “We have developed our own internal report card, based on state reporting standards from states such as Florida, and we use it as our own measure of success to monitor all of the reporting states. These tools are just another way that Healthesystems has invested in developing our own technology to ensure our programs deliver the most successful results.”
As part of the process for developing their state reporting tools, Healthesystems continually invests time and resources to remain engaged at the state level in order to ensure state agencies have visibility into issues that affect reporting stakeholders. Healthesystems actively participates in stakeholder meetings when states develop or consider changes to their reporting requirements and in certain states has been involved as a testing or beta submitter.
A challenge of workers’ comp state reporting in general is that while some common reporting standards such as those provided by IAIABC are used across states, many states have either implemented variations of these standards or do not use them at all, and therefore different types of reporting processes and measures are being used. For instance, one state’s report may focus on data integrity or performance turnaround time, where another report may focus on utilization or cost, thus requiring the need to monitor and maintain different performance metrics.
A customized and proactive reporting tool, such as the one Healthesystems has developed, allows the company to set its own benchmark and report high quality and accurate data in a very quick amount of time.
In addition, the company’s state reporting tool helps its insurance payer customers minimize the risk of exposure to penalties while removing the administrative burden of managing and reporting data to required states.