Press Release
Senior Whole Health Edits Claims
With Bloodhound Convergence Point
Real-time claims editing system provides start-up health plan for low income seniors with scalability and speed necessary to expand from one state to the next
DURHAM, NC – May 19, 2009 – Bloodhound Technologies, the only claims editing and analytics provider offering a fully transparent, customizable, real-time service, announced that Senior Whole Health (SWH), a voluntary healthcare plan for low-income seniors, has implemented Bloodhound’s ConVergence Point hosted claims editing service. A rapidly growing startup that provides integrated case management services for Medicare/Medicaid dual eligibles, Senior Whole Health implemented ConVergence Point as a core component of its claims processing system.
Senior Whole Health was started in 2004 by executives who had worked together at a Massachusetts neighborhood health plan for more than 20 years. Since its inception, Senior Whole Health needed claims processing systems that could handle claim volumes typically associated with much larger payers as a result of its dual eligible membership and rapid growth in enrollment.
To accommodate the processing volume, Senior Whole Heath CTO Mike Levoshko built a claims processing system internally with a proprietary Centralized Enrollee Record (CER), Microsoft.Net front end and an SQL Server database. Today, the Senior Whole Health claims processing system tracks a disproportionately higher number of claims per member with higher payments per claim than the average health plan. The system also tracks high levels of Activities of Daily Living (ADL) as required by Medicare. In evaluating technology vendors, Senior Whole Health looks for firms with complementary technologies and business philosophies.
“For our claims editing solution, Senior Whole Health wanted something that mirrored our philosophy — scalable, adaptable, fits anywhere, efficient. We also wanted a system that was architected in such a way that we could place it anywhere in the claims editing process from pre- to post-adjudication, and that’s what Bloodhound’s ConVergence Point does,” said Mike Levoshko, co-founder and CTO of Senior Whole Health. “With ConVergence Point, our CER can check out adjudication readings and provide edit explanations for doctors on our portal. This is a HUGE improvement because doctors won’t have to call us to find out why their claims were edited.”
The ConVergence Point implementation, both technical and clinical, with Senior Whole Health’s CER system was completed in six months. Since ConVergence Point is offered through a SaaS delivery model, the technical integration only required an interface between CER and ConVergence Point. On the clinical side, Bloodhound was able to customize ConVergence Point to exactly match Senior Whole Health’s reimbursement policies.
“Senior Whole Health needs a claims editing system that can support them as they expand operations from two to 50 states,” said Gary Twigg, CEO of Bloodhound Technologies. “With ConVergence Point, Senior Whole Health has the scalability and real-time speed necessary to grow into a national health plan provider.”
The only claims editing service to offer a fully transparent, customizable, real-time service for all participants in the claims revenue cycle, ConVergence Point can process a claim against 16 million edits across total patient history in sub-second response time. All ConVergence Point edits are open-sourced and based on national standards and can be filtered to exactly match a payer’s reimbursement policies. ConVergence Point also provides a Web portal for providers to see edits and correct claims before submission.
ConVergence Point is the first and only next-generation platform to offer pre-adjudication editing that provides healthcare payers significant operational efficiencies in addition to identifying overpayments.
About Senior Whole Health
Founded in 2004 and headquartered in Cambridge, Massachusetts, Senior Whole Health is a privately-held company offering intensive, integrated case management services for Medicare/Medicaid dual eligibles and includes Medicare Part D. Senior Whole Health’s Senior Care Options Plan (SCO) plan is designed for people who are 65 or older and live in the Senior Whole Health service area. Senior Whole Health’s Special Needs Plans (SNPs) serve the persons eligible for MassHealth Standard who reside either in the community or in a nursing home. For more information, go to www.seniorwholehealth.com.
About Bloodhound Technologies, Inc.
Bloodhound Technologies is the only claims editing service and analytics provider to offer a fully transparent, customizable, real-time service for all participants in the claims revenue cycle. ConVergence Point, its next-generation, hosted claims editing service, can process a claim against 16 million edits across total patient history in sub-second response time. All ConVergence Point edits are open-sourced and based on national standards and can be filtered to exactly match a payer’s reimbursement policies. Further, ConVergence Point provides a Web portal for providers to see edits and correct claims before submission. This remarkable service can integrate with any claims adjudication system, clearinghouse, or claims gateway.
Based in Durham, NC, Bloodhound Technologies is a venture-backed company with investments from Noro-Moseley Partners and The Wakefield Group. For more information, visit www.bloodhoundinc.com.
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Contacts:
David Jackson
Bloodhound Technologies, Inc.
919-313-1651
djackson@bloodhoundinc.com
Christian T. Potts/Madeline Shedno
Schwartz Communications
781.684.0770
bloodhound@schwartz-pr.com