ServData provides periodic updates and enhancements to our products. These updates include, but are not limited to, membership downloads, code table updates, software enhancements and software patches. ServData will notify clients via email when updates and enhancements are available for download. Updates are automatic for both the Data Warehouse and ACO Solution, and can be transparently initiated in the SOS software application.
Our Data Warehouse web solution converts raw transactional data- demographic, financial, utilization, episode of care, HCC- into a user friendly desktop application that allows you to analyze your organization's cost efficiency. Detailed analysis of raw claims data from Healthcare Plans and CMS is used to successfully manage global risk contracts and participate in shared savings programs.
Analyze Healthcare Trends - Standard and customized graphs/reports provide the ability to analyze claims data per facility, line of business, fund, paid month, service month, diagnosis, procedure, specialty and provider. This data can be supplied as "summary health information" or in a more detailed fashion depending on your plan documents and HIPAA requirements.
Monitor Medicare Risk Adjustments - Quickly view practice average Hierarchical Code Condition (HCC) scores and view corresponding member funding. HCC reports detail total claims paid with member score. Identify members with high/low scores for chart auditing.
Calculate Referral Costs - Easily examine which specialists are most cost effective for referrals. Compare referral costs on a gross dollars or per member per month (PMPM) basis. Audit monthly claims to ensure contracted rates apply. Identify and calculate contestation amounts with user-defined parameters.
Audit Monthly Claims Reimbursements - The Data Warehouse software is updated monthly based on most recent claims paid data. This allows users to audit monthly payer reimbursements and ensure claims are properly paid. Contestation reports can be developed and printed in minutes.
Analyze Membership Trends and Stop Loss - View and print out reports that show patient flow trends by facilities and lines of business. Stop loss reviews are easily created by user-defined "date of service" ranges and "claim expense" limits.
Identify and Manage Disease States - Monitor claims by specialty, diagnosis and procedures. Identify high utilization areas where members could benefit from wellness programs.
View Funding and Expenses - See dollar amounts funded for Part A, Part B, Primary Care, Supplemental and Stop Loss funds. View dollars in a PMPM or Gross format. Compare paid claim expenses to funds and see monthly operating margins.
Our web-based ACO Solution is designed to assist in the utilization of beneficiaries enrolled in Accountable Care Organizations (ACO). This application uses claims data from CMS to produce graphs and reports by beneficiary. If you are interested in seeing your ACO data at no obligation, click here!
Target Quality Performance Measures - Determine whether beneficiaries have met many of the specific Quality Performance Measures as identified by CMS.
Identify Network Providers - With ACO supplied NPI numbers, differentiate claims originating from ACO providers and out of network providers.
Review Beneficiary Utilization - Manipulate claims line item detail to see all costs generated by the beneficiaries of the ACO. View claims by provider and beneficiary to produce a wide range of utilization reports.
Determine Primary Care Accountability - With ACO provided beneficiary physician assignments, accountability can be assigned at the primary care level.
Track Individual Beneficiary HCC Scores - Identify the individual ICD-9 codes that comprise the HCC score and track them to ensure they are maintained to prevent a drop in the Benchmark figure.
Manage Beneficiary Attribution - Beneficiaries can be attributed via CMS's methodology or via the individual ACO's methodology.
Identification of Beneficiaries without a Data Sharing Preference - Beneficiaries who have not selected a data sharing preference according to CMS files can be identified.
XML File Submissions to CMS - Beneficiaries identified as having no data sharing preference can be transmitted to CMS via XML files.
SOS is a fully integrated practice management system, designed to meet the needs of healthcare professionals managing physician offices in a constantly changing healthcare environment. Whether you're working with managed care or fee for service patients, S.O.S. provides the tools needed to make practice management seamless.
Maintain Patient Records - Create your patient record with as little information as a name. Maintain extensive demographic data on patients and access regular membership downloads from your payers.
Schedule Patient Appointments - Schedule office visits with a few simple clicks of the mouse. Reschedule appointments with a click and drag. Block out lunch periods, physician vacations and office closures.
Managed Care Referrals - Access required referral forms for all of your managed care contracts. Submit via paper or electronically. Print individual forms for your patients as needed.
Patient Ledgers - Define custom fee schedules. Collect patient co-pays upon patient check-in and apply payments as needed. Track patient balances, run accounts receivable aging reports and post explanation of benefits (EOB).
Billing- Customize your superbills and access payer specific forms for encounter submissions. Bill on CMS1500 forms or output claims in several formats for electronic billing.
Create Custom Reports - Detailed reports are accessible by a variety of search criteria. Print daily appointment schedules, provider listings, product and specialty reports. Quickly pull a patient roster targeting a specific population by provider, age, sex or insurance.