© 2021, nThrive Revenue Systems, LLC. All rights reserved. RO821
2021 VIRTUAL USER FORUMS
PRODUCT STRATEGY AND ROADMAP OVERVIEW
Claims Management
Taylor BynumDirector of Product Management
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2022 Roadmap and Cross Product Integrations
Roadmap items on the Radar
Poll – Medicare DDE Emulator
Poll – Word Cloud – Missing Features
Poll – Availability/Uptime expectation
Brief comments on transition to the web
Open Q&A
Claims Web Application Claim Attachments
WHAT
• Attach and submit electronic Medical Records via Jopari• Confirmation of attachment submission• Import reconciliation of attachments to Claim• Edits to drive attachment management for supported payers• Manually Attaching Medical records
WHY
• Market demand for electronic medical records• Decrease cost to collect for clients• Increase overall claims value proposition• Buys time to set up clearinghouse connectivity for attachments by
using a trusted partner Q1
Automated
Attach and
submit
medical
records
Review
supporting
payers
Q4
Q3
Q2
Manual
Attach of
Medical
Records
Improve Client Efficiency and Experience
Review
Supporting
payers
TIMELINE
Amerigroup
ANTHEM BC CA
ANTHEM BCBS CO
ANTHEM BCBS CT
ANTHEM BCBS MO
ANTHEM BCBS NV
ANTHEM BCBS OHIO
ANTHEM BCBS VIRGINIA
Anthem Blue Cross Blue Shield Georgia
Anthem Blue Cross Blue Shield Indiana
Anthem Blue Cross Blue Shield Kentucky
Anthem Blue Cross Blue Shield Maine
Anthem Blue Cross Blue Shield Nevada (Medicaid)
Anthem Blue Cross Blue Shield New Hampshire
Electronic Attachment Payer Connections
Anthem Blue Cross Blue Shield Wisconsin
Anthem Maine Health
BCBS Western NY (Medicaid ONLY)
BCBSMN BLUE PLUS MEDICAID
CLEAR HEALTH ALLIANCE
COLORADO COMMUNITY HEALTH ALLIANCE
DELL CHILDRENS HEALTH PLAN
EMPIRE NY
Healthy Blue Dual Advantage
Healthy Blue Louisiana
Healthy Blue South Carolina Medicaid
Healthy Blue South Carolina
NC Healthy Blue
SIMPLY HEALTHCARE
BCBS of AL
EMI
National Government Services (NGS) - J6 IL Part A and B
National Government Services (NGS) - J6 MN Part A and B
National Government Services (NGS) - J6 WI Part A HHH (AK, AZ, HI, ID, MI, MN, NV, NJ, NY, OR, WI, WA) and Part B
National Government Services (NGS) - JK CT Part A - Empire BCBS Ny and Part B
National Government Services (NGS) - JK MA Part A and B
National Government Services (NGS) - JK ME Part A HHH (CT, ME, MA, NH, RI, VT) and Part B
National Government Services (NGS) - JK NH Part B
National Government Services (NGS) - JK NH, VT Part A
National Government Services (NGS) - JK NY – 2 and 3 Part A and Part B
National Government Services (NGS) - JK RI Part A and B
National Government Services (NGS) - JK VT Part B
New Payer connections will be continually evaluated, edits will be updated accordingly
All Jopari Worker’s comp attachments will be included in offering
Claims Web Application Follow Up, Remittance Management, Manager
WHAT
• Follow Up - Deliver find and search EOBs from web application UI• Cash Posting - Deliver find and search Remittance files in web
application• Begin Self Service Insurance Master (Q4)• Provide Bulk update, validate and alerting• Allow access to look up and view system reports• Example: Download/misc
WHY
• Complete additional user personas in the web application• Fill functionality gaps between classic version and web application• One step closer to complete general availability• Setup for future self-service functionalities
Q1
Q4
Q3
Q2
Improve Client Efficiency and Experience
TIMELINE
Search
EOB
available
Bulk Claim
Update
Bulk Claim
Validate and
Alerting
System
Report
Access
Self Service
insurance
master
Remittance
lookup
Claims Web Application Biller Enhancements
WHAT
• Editor - Medicare Direct purge, bypass and request eligibility• Editor - Code lookups inside editor • Editor - Edits with KS content links• Bulk Update, Bulk Validate and alerting• Invalid Import processing updates
WHY
• Complete additional user personas in the web application• Fill functionality gaps between classic version and web application• One step closer in complete general availability• Provide additional value to claims and KnowledgeSource product
integration• Allow more flexibility for invalid imports to allow clients to make
more decisions on processing
Q1
Q4
Q3
Q2
Improve Client Efficiency and Experience
TIMELINE
Medicare
Direct
Code
Lookups
Invalid
Imports
Bulk
Update
Bulk
Validate
and
Alerting
Knowledge
Source /
Claim
Validation
integration
Cross Product Integrations
WHAT
• Transition from external third-party to internal screen scraping capability to internal Claim status requests to nThrive’s Clearinghouse Services
• Integration with Claims Analytics and Collections • Contract Management on the radar
• Further integration with KnowledgeSource content with edit correlation. Upstream capabilities in the EMR.
WHY
• Decrease cost to implement and support Claim Status• Create better user experience utilizing analytics• Create better user experience for Collections Management users• Increase client revenue by increasing eligibility and CSA
transactions
Q1
Clearinghouse
Service
(CSA/276)
Collections
Integration
Claims
Analytics II
Q4
Q3
Q2
Knowledge
Source
Claims
Analytics
Claims I
Improve Client Efficiency and Experience
Contract
Management
Reprice
(Market
Assessment)
TIMELINE
CVS/Embedded Claims
WHAT
• Payer-specific Edit Bypass/Inactivation• Partial Claim Editing and Cross Claim Editing (Cerner)• Embedded KPI metrics in Claims Analyzer• KnowledgeSource Edit service integration• Edit Category Mapping Overrides + Field Mapping Updates• Claims Web Integration with CVS portal
WHY
• Additional Edit Self Service capabilities to improve ease of use• Embed edits further upstream for Cerner differentiation (Partial
Editing)• Provide better content to end user via KS integration• Better support capabilities in CVS Portal
Q1
Q4
Q3
Q2
Increase the usability and integration of CVS
TIMELINEPartial
Claim
Editing
HIM Payer
Edits
Cross
Claim
Editing
Portal /
Claims Editor
integration
Payer
specific Edit
inactivation
Portal
Internal
Features
Windows
Server
Migration
Round Trip
Validation
Windows
SQL
upgrade
ON THE RADAR
Pending Market Validation
Denial Probability Scoring
Machine Learning / AI
Automated missing ERA case creation
Machine Learning / AI
Retro Prior Authorization
Robotics Process Automation
Contract Management Claim Repricing
Denials Management Lite
Clearinghouse Payer Mapping and Management
Self Service
*Claim rejection categorization
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Claims Web and Claims AnalyticsDemo
14
Q A&
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