With a huge rise in the premiums of private health insurance policies and the co-pay, the cost of healthcare including maternity costs is continuously increasing causing a hefty price burden on the American consumers. One major factor that acts as a hindrance in curbing the cost of healthcare is an absence of price transparency.
2023-10-25
Zigna’s AI Payor Policy Edit Technology
Most revenue cycle claims editing companies focus on Centers for Medicare and Medicaid (CMS), National Care Determinations (NCD), Local Care Determinations (LCD), and broad national standards. Those are great baselines for medical claim editing, but what moves claims editing from baseline into claims editing with accurate efficiency? How do you decrease denials on the provider side and decrease overpayments on the payor side?
ZignaAI’s payment policy catalog
Zigna’s Payment Policy Catalog provides clean and quick access to payor payment policies with the ability to view by subject, line-of-business, payor, facility/professional, and geography. Zigna’s payment policy catalog, with up-to-date policies, has been built with payors and providers in mind. When you need to understand healthcare payment and reimbursement policies from your unique angle, Zigna’s payment policy catalog delivers.
How is this accomplished?
ZignaAI‘s Human enabled technology; where AI enhances the human touch to extract payor payment policy edits faster and with increased accuracy. Zigna’s AI editing technology is embedded in RevMaxAI, an application built for payors and providers to improve claims submission accuracy, claims adjudication turn-around, and transparency in healthcare claims billing.
Pre-pay or post-pay, ZignaAI payment policy catalog with edits is a great fit. Whether you are focused on claims selections, auditing the claims, applying edits, focused on selecting claims for audit, writing payment policies or researching how to bill with efficiency, ZignaAI may be the solution you need. We would love to hear about your unique needs and how our solutions can help.
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Health insurance across the US has adopted their own languages, not only across the healthcare industry, but within each payor. If your staff is tasked with locating and reading payment policies you know how time-consuming and confusing it can be, not only to find the policies.
CMS’s price transparency rule is to make healthcare costs transparent and allow patients to compare prices across hospitals to find facilities that offer the same service at a lower cost. But a recent survey conducted by Kaiser Family Foundation (KFF) identified that most of the adults are unaware of this rule.
The growth of health care cost-sharing in recent years has led to increased demand for price transparency. Federal government, State legislatures and corporate boardrooms have responded with various programs to make the costs of health care services more accessible.
Price transparency involves informing, preparing, and involving individuals about treatment costs before receiving them. It essentially improve healthcare standards and encourage individuals to get the right treatments without intentional or unintentional delays. In the United States, health spending was found to have increased by 2.7% in 2021 to $4.3 trillion.
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