Data Gathering for Contract Management and Claims Analytics
KREG’s Contract Management Analytics system (CMA) uses the most accurate data possible ensuring the most accurate information for your organization. KREG uses scrubbed claims sent to your payers so you are sure CMA is calculating based on exactly the same information the payers are receiving. We pull actual payment postings from your Health Information System as well so you will be confident underpayment reports you see reflect the most accurate information available.
In addition to claims and postings we import user defined fields to accommodate special calculations in your contracts. If you are interested in denials management we load the 835 electronic remittance files payers send to you. KREG can also export a transaction file for loading contractuals back into your HIS or billing system for more accurate financial reporting.
As shown above, these are all the different data types used in KREG’s Contract Management Analytics system.
837 Scrubbed Claims
CMA imports a data feed from your scrubber of the same claims going out to your payers.
835 Electronic Remittances
CMA imports the 835s as they come back from the payers. This gives you more information on how and why the patient did or didn’t get paid and is instrumental in tracking denials or performing payment compliance.
Actual Posted Payments and Contractuals
These transaction files are provided by your HIS as text files that are loaded into CMA.
User Defined Fields
These are text files from the source system that contain fields that may not be on the claim (e.g., APR-DRG) but are required to model the contracts. These may also be fields to address custom reporting needs of your staff (e.g., Product Lines).
Contract Terms and Conditions
This is the information needed to model the contracts in CMA to provide accurate calculations. We need the details of the contract along with any fee schedules or other rates files referenced in the contract. Fee schedules may be loaded directly from the Excel files the carriers normally provide.
Once we have these feeds we will put everything together to build an accurate contract management system. When it is up and running it can provide data to other systems in your organization. CMA will provide accurate expected payments to KREG’s Decision Support system (PLM) for detailed profitability reporting. You may also use CMA to export contractual allowances and import them into your HIS for posting adjustments for more accurate financial reporting.
CMA accepts other data from KREG’s Decision Support system (PLM) as well. Costs generated and stored in PLM pass to CMA during the automated import process. Having both expected reimbursement and cost data allows users to determine if a proposed contract is profitable before agreeing to terms. This enhances the hospital’s negotiating power during the contracting process.
For more information on this process drop an email to firstname.lastname@example.org and request more information.