InfosysPublicServices - Member Liability Estimator Solution | MLE Applications
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The document discusses the Member Liability Estimator (MLE), a solution designed to provide accurate and real-time estimates of patient liability and cost of care based on insurance benefits and provider contracts. This web-based tool combines statistical models and real-time data aggregation to improve pricing transparency, enhance member satisfaction, and streamline cash flow for providers. Infosys Public Services offers this adaptable solution to healthcare organizations to help them engage consumers effectively while minimizing implementation costs.
InfosysPublicServices - Member Liability Estimator Solution | MLE Applications
- 1. Member Liability Estimation Solution ................................................................................................................................................................................................. As Consumer Driven Health Plan (CDHP) products continue to gain traction with employer groups, patient payment as a percentage of out-of-pocket expenses and provider’s total revenue will rise further. Health plans are strong proponents of price transparency, believing it is essential to engaging consumers in health decisions. They believe consumers need understandable information about the price and quality of health care services to make informed purchase decisions and hence are investing in transparency efforts to provide comparisons of price, quality and efficiency before a patient takes a service. Though providing an estimate on the cost of care is relatively straight-forward, providing meaningful accurate pricing information relevant to the patient (considering patient’s insurance benefits, specific medical condition and expected treatment) is a lengthy & complex process. There is a need for a solution which will not only provide accurate estimates but also follow a simplistic approach without having the payers to make much investment in claims adjudication systems. The Member Liability Estimator (MLE) solution is a statistical model based framework for estimating cost of care and Member Liability at the time of availing the services. The solution generates member liability estimates in real-time, based on payer specific contract details, provider pricing and historical claims data. It generates estimates with accuracy and less processing time leveraging its unique approach of cost estimation and configurable features with interactive member-friendly UI. Features ................................................................................................................................................................................................. Our MLE offering is an interactive web-based tool that combines intelligent statistical model based estimation techniques for estimating cost of care as well as real- time data aggregation for calculating the liabilities based on benefit/plan and provider contract details. The key features of the tool are: • Hybrid Model - statistical model for calculating estimated cost of care and a rules engine/claim adjudication engine for real-time calculation of member liability based on benefits data • Member level liability estimation based on coinsurance, co-pay, out-of-pocket limits and deductibles • Real-time recommendation of service groups for estimation based on pre-configured rules • Complaint to ICD-9 and ICD-10 coding standards • Quick and accurate response with display of estimation and Cost comparisons between providers Fig. MLE - Solution application screen snippet • Real-time member liability estimation, predicting the probable cost of service, upfront visibility around liability with accurate estimates for financial planning BENEFITS • The statistical model based approach is advantageous over traditional real-time pseudo-claim based approach since it doesn’t need any changes to payer systems. The statistical approach also improves performance and addresses various other scalability issues associated with real-time approach. • Strengthen Provider AR collections based on estimate, speeding up the cash flow • Lower cost of implementations due to adaptability with existing systems • Increased Member Satisfaction with accurate financial planning and anticipation and Simple interactive user interface for getting the estimates quickly • Strong harmonization of IT solution combined with CRM services www.infosyspublicservices.com
- 2. Service Offerings Infosys Member Liability Estimator Offerings Consulting & O perations Program Management Steady Support • Implementa tion and • Implementation and evel 1,2,3) Adoption Stra • Help Desk (L tegy and Adoption Strategy and ement Roadmap • Data Manag Roadmap re Hosting • Enterprise • Infrastructu Data Dictiona • Enterprise Data Dictionary Set up ry • SaaS Model Set up • Data Minin • User Training g • Data Mining • CRM oper ations • CRM operations • Ready-to-deploy solutions and products for ICD9-10 Conversion • Ready-to-deploy models for statistical Analysis • Pre-Configured Service groups for important disease conditions Solution Tool-kit • Customizable and Scalable: This solution has configurable framework across different business intelligence PROPOSITION platforms, adaptable with payer as well as CRM systems and hence can leverage existing investments. This Solution is scalable and viable for all claim platforms and is adaptable to all types of data/ communication VALUE standards • Accuracy in output due to combination of statistical as well as real-time data aggregation models, with rule based service groups configured for member’s existing health conditions • Competent Resource Pool & Delivery Excellence: Large number of data mining and statistical modeling consultants, strong CRM operations. Leveraging our engagement accelerators, governance models, process tools, and templates to deliver integration and analytical services with high quality, productivity and reliability at significantly lower cost and in reduced time About Infosys Public Services Infosys Public Services is a U.S based subsidiary of Infosys (NASDAQ:INFY), a global business consulting & technology services company. Infosys Public Services helps Healthcare & Public sector clients to transform, innovate and optimize their organizations to build tomorrow’s enterprise. We blend 30 years of commercial best practices with innovative industry solutions, best-of-breed partner content and proven execution to deliver measurable business value with predictability. For more information, contact askus@infosyspublicservices.com www.infosyspublicservices.com © 2012 Infosys Public Services, Plano, Texas, USA. Infosys Public Services believes the information in this publication is accurate as of its publication date; such information is subject to change without notice. Infosys Public Services acknowledges the proprietary rights of the trademarks and product names of other companies mentioned in this document.