by David Hawkes
Chief Technical Officer and Product Manager
MphasiS Healthcare Solutions, an EDS Company

Once upon a time, human resource (HR) and benefits administration represented rows of clerks shuffling and filing paperwork; but today it means stacks of computers performing automated, paperless processes. HR administration is fast becoming the most outsourced business process because of efficiency and cost effectiveness, and accounts for nearly 20 percent of the business process outsourcing (BPO) market worldwide. Among the most outsourced functions are back-office services such as payroll, employee benefits, education and training.

by Deborah Godes
Director, Healthcare Industry Practice
ConnectYourCare

Every industry experiences a dramatic change or several changes at some point in time. Just look at telephones – rotary dial telephones have morphed into palm-sized cell phones with cameras. The healthcare industry is no exception; some changes have been cataclysmic while others have been less dramatic. All evidence suggests that Consumer-Directed Healthcare (CDH) is somewhere in between. Regardless, movement seems to occur at the speed of light, and to stay competitive health plans must be able to move at the same speed.

by David Jackson
Bloodhound Technologies

Claims editing involves checking claims for upcoding, bundling and unbundling of codes and duplicate entries. Claims editing typically saves payors between 3-8%. While many off the shelf claims transaction systems have some native editing and duplicate checking abilities, these systems are designed to adjudicate claims. As such, even the most robust transaction systems need some augmentation to their native editing sets and duplicate logic. 

Coalition America, Inc. (CAI) has announced it will be introducing repricing and cost containment technology in the first quarter of 2007 for managing dental claims. Offered through an online claim repricing application or electronic data interchange (EDI), this new product will help streamline claims processing by offering both medical and dental claim repricing through one source.