Custom repricing that reacts to the payor automatically
Markup and admin-fee claims carry a health-plan AR component for funding, and the accounts payable to the provider has to stay separate from it. Claims-Flow reprices both sides and keeps reversals from taking too much back.
Talk to our team →Unique claim challenges our clients face
- Inefficiencies from the constraints of traditional claims adjudication platforms
- Managing data exchange with the health plans (members, accumulators, reporting)
- Processing and tracking time-sensitive appeals outside the claims system
- Integrating with UM and other systems that impact claims payments
AP and AR, priced separately on the same claim
This is a markup/admin-fee claim with a health-plan AR component for funding. Notice that the accounts payable (AP) is kept separate from the accounts receivable (AR), so funding and provider payment never get conflated.
Many clients price claims against custom contracts with both the payor and provider: a risk-based per-member-per-month arrangement, a percentage of allowable, or something else. Claims-Flow handles it.
Reversals that protect the provider
Recoupments and repayments from the health plan (AR) are handled automatically on the provider side (AP). Reversal adjustments are repriced too, so you never take too much back from the provider.
Online tools for real-world contracts
Contracts and fee schedules are managed with online tools that handle the common edge cases without forcing you to repeat the same data again and again.
See repricing on a real markup claim
We'll walk through how AP and AR stay separate while reacting together.