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Health Plans

Payer Compass helps health plans drive down total claims solution spend by cutting through complexities and simplifying healthcare pricing.

Visium product model

Next-Gen Pricing Transparency and Contracting Solution VisiumТМ

Our transformational solution, Visium™, makes it simple to load and manage contracts, apply real-time edits and regulatory updates, and process pricing/repricing, helping you improve accuracy and reduce frustration. Visium™ can be configured to any plan’s goals, while also making it simple to automate reimbursement terms as you scale to accommodate multiple providers, contracts, groups, rate customizations and claim volume.

  • Pricing & Editing Engine
  • Contract Management
  • Audit & Reporting
  • Modeling & Analytics

Contributors

Visium™ can handle health plans of any type, including Medicare, Medicaid, commercial, reference based pricing, TRICARE, VA, and specialty types such as Tribal, indigent and prisons. Visium™ also contains all methods of pricing so you can price any claim type.

VisiumТМ Platform

Visium™ consolidates clinical editing, contract management administration and reimbursement methodologies all into one customer-centric, nimble resource.

You can submit information in flat file, EDI batching or using an API connection. Once all your contract data and payment terms are loaded, Visium™ matches the claim to the appropriate contract and then applies the correct contract edits and standard logic and reimbursement terms, plus any custom logic and reimbursement terms set by you. All of this is visible to you anytime through the platform portal.

Output

Processed claims are returned in the submitted format for seamless workflow integration. Each claim has its own process trail that consolidates terms and edits, making it simple to confidently communicate with providers about how you arrived at the price and reimbursement amount. In addition, modeling, analytics and robust customizable reporting help you better review the data to meet your plan and operational goals.

Visium product model

Data Connections

Maximize your claim operations thanks to our unbiased, seamless workflow integration with nearly 30 EDI vendors and 23 unique claims adjudication systems and clearinghouses.

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Additional Solutions for Health Plans

Maximize your VisiumTM investment with these additional solutions.
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Encompass

Value-based reimbursements allow you to easily bundle payments to improve care and cost outcomes.

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Benchmark

Achieve better plan performance through the use of data analysis and comparative modeling.

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