Payor Provider Analytics

Payor Provider Analytics

In today’s value-based care environment, payors and providers are exploring innovative partnerships to work in lockstep to achieve best patient outcomes, at low cost while maintaining high quality. This is easier said than done, when the payor-provider relationship is often stressful and the goals arent properly aligned.
HOAP Health empowers payors with powerful analytical tools that can aggregate the claims data and analyze it myriad ways – by provider, service line, region, demographics, health plans, pharmacy, revenue code, procedure etc. HOAP Health’s AI driven algorithms give payors insight on the accuracy of claims while searching for hidden patterns of aggressive coding, mis-coding, over charges, wrong charges or fraudulent charges. Once data anomalies are identified, HOAP flags the “suspect” claims to take corrective actions before claims are reimbursed.

Key Features & Benefits:

  • Comprehensive view of provider performance across the network
  • Visibility by provider, location, procedure, patient type, service line and quality to optimize  costs, increase productivity, and grow revenue
  • Insight to negotiate better contracts, bundled payments, and at-risk services
  • Steer care to high performers with “KYD – Know Your Doctor” insight
  • In/Out of Network Analysis, and Excess Charges
  • Optimize Cost of High Value Drugs, Procedures, Implants

Bottom Line:

HOAP Health’s Payor Provider Analytics gives actionable data-driven insight on claims and reimbursements across all providers, distinguishes leaders vs underperformers, flags suspect claims, improves accuracy in remits and health plans viability.