Healthesystems has designed a unique and revolutionary approach to manage workers’ compensation ancillary medical services. This groundbreaking solution provides clients with a centralized tool for managing the quality, costs and services of their ancillary providers in real time. Our proprietary ABM solution prospectively adjudicates all ancillary services prior to being provided, resulting in greater savings and optimal utilization.
Our centralized platform for managing all ancillary vendors, Verticē, allows claims professionals to perform real-time referrals and authorizations.
We removed the complexities from a cumbersome system. We replaced it with a fully managed transparent solution with customized workflows. We automated everything from referrals and prior authorizations to billing and payments. Gone are the manual tasks, endless calls, emails and bill disputes. In its place is an efficient system that:
Our focus on medically appropriate, quality care sets our ABM program apart. The involvement of our Clinical Services staff in our ABM solution provides payers with an added measure of confidence that physical medicine, home health, and additional services are being managed in accordance with evidence-based medical guidelines.
Our proprietary detailed coding structure eliminates guesswork. We assign unique codes and descriptions to every product – more descriptive than the commonly misused HCPCS codes. Payers no longer struggle with mysterious miscellaneous codes. They know exactly what product or service a claimant will receive and how much it will cost before they are delivered and the bill arrives. That’s the power of prospective adjudication in real time.
This high level of detail eliminates waste and provides a basis for comparing vendors’ performance against one another with our vendor management scorecard. We drive optimal performance and set best practices among all ancillary vendors to deliver better outcomes.
Our innovative ABM solution achieves significant cost savings through:
