For CostFlex clients that have the Payer Contracts Analyzer module, they have the ability to process and report the Pricing Transparency now!
To assist our clients with this task and required reporting, CostFlex has been working directly with existing clients for the last several months to perfect the classification of “Shoppable Services” by payer (a requirement) and to marry these with their automated payer contracts in CostFlex.
The solution that CostFlex clients are using consists of a three-step process that involves existing tools:
- Using the Product classification utility (CostFlex specific tool), clients can classify patients into one of the 300 shoppable services.
- Using the Payer Contracts Analyzer module, each of these classified patients can then be calculated against 100% of all the client’s modeled contracts to calculate the “Allowed Amount,” or what each insurance contract would reimburse.
- Using the provided standard exports, a statistically significant collection of patients can then be grouped by Shoppable Service with the Allowed Amount for each contract displayed and exported for use by the hospital team for publishing.
If your hospital does not have the IT staff to handle the presentation layer, CostFlex has created a custom presentation layer to help them (or any other organization that needs a presentation layer for Transparency).
If the export is sent to CostFlex, then we will update a database with a link to a website that the end user (i.e., hospital) can place on their own website with a forward-facing form for patients to access and see their rates.