As a core function of our benefit management solutions, we process and manage all types of data, including provider data, multiple payment methodologies and member eligibility. With the Enterprise System, we’re able to provide comprehensive file processing and data management tailored to each client’s unique requirements, proprietary file formats, and customized reporting layouts and schedules. Our solutions deliver greater oversight and insight into benefit management, enhancing our clients’ decision-making around health data management and their business agility.
Eligibility & Enrollment Data Management
Vestica Healthcare uses the Enterprise System platform to accurately and efficiently maintain, reconcile and verify member eligibility. Member eligibility is verified based on plan design, date of service, member and dependent enrollment information and other data based on the business rules as defined by each client. We streamline claims processing and data management of members with dual eligibility as well.
We also provide enrollment data management tailored to each client’s business requirements. With the Enterprise System, we can efficiently make mass updates to eligibility and enrollment.
Encounter Data Management
Our clients rely on us to help them remain in compliance through accurate, timely and thorough encounter data reporting on government benefit programs. We have extensive experience designing and delivering encounter data extracts, custom data extracts and detailed reports in a variety of formats which meet state and federal requirements. In addition, any information stored in our databases can be repackaged into client-defined reports without requiring a programming change to the system.
Provider Data Management
We deliver streamlined, sophisticated provider data management which improves data quality and allows for rules-based automation and mass update capabilities. Our system is modeled to reflect real world scenarios where one provider may practice at multiple locations, in multiple states, in various networks, with differing reimbursement methods and fee schedules—all without duplicating any data. Any changes to provider data take effect in real-time and automatically update referenced data throughout the entire system, including dashboards, reports, and customer service tools. Through our technology, our clients can also attract top providers in each market with online contracting and credentialing, and stay more closely connected to their networks.
We put the analytical power of the Enterprise System into the hands of our clients with real-time, online, 24/7 reporting. Clients have access to a comprehensive range of on-demand reports which can be exported in a variety of file formats, including PDF, CSV, XML, and Excel. In addition, any data stored on our databases can be easily extracted and repackaged into scheduled reports to meet client requirements for data, layout, and file format without a programming change to the system. Customized, client-defined reports can be generated and delivered automatically based on configurable schedules.