Core Solutions - EHR Solutions for Behavioral Health

Cx360 Payer > Finance

Funding Source Management

As a SSA or a SCA, your goal is to maximize utilization of funds from various sources. This usually becomes even more important at the end of the fiscal year as staff tries to review actual utilization against allocations and make necessary adjustments. With Cx360 Payer, funding source management occurs in real time, eliminating the stress of fiscal year end adjustments.

Cx360 Payer provides capabilities to define funding source business rules/criteria for utilization of funds, to assign one or more funding source(s) to each client, and to allocate funds at the program/authorization level. With these capabilities, you will be able to see both allocated and utilized funds by source, provider or service. The capability to dynamically change funding sources mid-stream is also very valuable. With a few mouse clicks, you will be able to get real time, accurate, funding source utilization data.
back to top

Authorizations Management

Traditionally, the authorization management process has been driven by a system of paper forms and fax machines. With Cx360, providers can request authorizations online, with automatic routing to the right personnel for review and approval of requests. All the clinical data required for review is collected and validated before data submission to ensure an accurate and quick turnaround. With this process, authorizations requests and approvals can be completed within minutes, instead of days/weeks. The result: improved access to client services.
back to top

Claims Processing

Handling claims is a key business process—and a significant area of overhead—for any provider organization. Estimates for the cost for preparing claims, vary from $3.00 to $7.00 per claim. In addition, providers, especially smaller organizations, have claims denial rates above 5% of revenue. Having an efficient way to process claims can reduce costs and denial rates, allowing providers to focus on delivering quality care.

• Configure payer specific business rules (service limits, credentials, authorization requirements etc)
• Generate electronic billing in 837 Institute/Professional format
• Generate paper claims in CMS 1500, UB 04 and other formats
• Generate client statements
• Complete progress notes and automatically generate claims

back to top

Claims Adjunction

The Claims Adjudication functionality allows payers to process incoming claims in a cost-effective manner. According to the Center for Policy Research, America’s Health Insurance Plans (an industry trade group):

• The average cost for processing electronic claims was $0.85 versus $1.58 for paper claims.
• The average cost for processing pended claims was $2.05

We have found these statistics to be significantly higher within the behavioral health specialty, where a significant portion of claims involve manual processes. With Cx360, SSAs can automate the claims adjudication process based on HIPAA Standards (837 Institutional and Professional), send out Explanation of Benefits (EOBs), and reduce processing costs per claim.
back to top

Contract Management

Whether you have 30 providers or 3,000 providers in your network, managing contracts and associated business processes is a time consuming process. With Cx360, provider’s can use self-service tools to manage their facility capacity information—simplifying the process and ensuring up-to-date information. For SSAs considering performance-based contracts, Cx360 provides the necessary tools to both structure and monitor performance measures. Examples of performance measures include:

• Number of days from initial request to admission
• Number of readmissions to the same or higher level of care
• Number of discharges to a lower level of care
• NOMS

back to top