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Description

It is accurate to assert that "not all DRG vendors are equal." Although their marketing strategies may be similar, these vendors generally fall into two categories: those that cater primarily to provider hospitals and those focused on detecting overpayments for health plans and payers. Much like how attorneys often concentrate on either defense or plaintiff cases, auditing vendors tend to specialize in the distinct needs, cultures, and priorities of their respective clients. Within the realm of payer-focused vendors, a diverse array of strategies for DRG auditing and overpayment detection exists. Our service offerings also include a dedicated physician review team that generates clinical validation findings, specifically addressing cases where identified issues stem from unsubstantiated clinical diagnoses made by treating physicians, which goes beyond the capabilities of coders. Our findings consistently demonstrate that our coding compliance model yields verified savings, contributing to enhanced financial efficiency for healthcare providers. Thus, selecting the right vendor can significantly impact the financial health of both hospitals and payers alike.

Description

Achieving significant advancements in both clinical and administrative outcomes, Evolent Care Partners, a healthcare system in the Midwest, has earned the distinction of being ranked third nationally for both total shared savings and the percentage of savings against benchmarks. By providing independent primary care physicians with essential capital and resources, Evolent Care Partners empowers them to engage in and thrive under two-sided payer contracts while mitigating their financial exposure. New Century Health enhances cost-effectiveness and quality of care in oncology and cardiology by leveraging clinical evidence to inform care decisions, a process that enjoys support from both payers and providers alike. Furthermore, Evolent Health Services streamlines health plan operations through a suite of comprehensive services backed by a modern, integrated platform and a genuine model of strategic partnership. Additionally, the organization encourages exploration of insights and news related to value-based care, population health, health plan administration, and various topics concerning the transformation of healthcare. Through these initiatives, Evolent aims to foster a more efficient and effective healthcare landscape.

API Access

Has API No 

API Access

Has API No 

Screenshots View All

Screenshots View All

Integrations

OpenPM No 

Integrations

OpenPM Yes 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Customer Support

Business Hours Yes 
Live Rep (24/7) Yes 
Online Support Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) No 
In Person Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) Yes 
In Person Yes 

Vendor Details

Company Name

DRG Claims Management

Founded

2009

Country

United States

Website

www.drgclaims.com/solutions/

Vendor Details

Company Name

Evolent Health

Founded

2002

Country

United States

Website

www.evolenthealth.com

Product Features

Product Features

Benefits Administration

COBRA Administration Yes 
Claims Management Yes 
Deduction Management Yes 
Disability Insurance Administration Yes 
Employee Benefits Administration No 
FMLA Administration No 
FSA Administration Yes 
Flexible Spending Accounts No 
For Brokers No 
For Employers No 
HIPAA Compliant Yes 
Health Insurance Administration Yes 
Life Insurance Administration Yes 
Online Benefits Enrollment Yes 
Premium Billing No 
Provider Management Yes 
Retiree Administration No 
Retirement Plan Management No 

Claims Processing

Adjustor Management No 
Case Management No 
Claim Resolution Tracking Yes 
Co-Pay & Deductible Tracking Yes 
Compliance Management No 
Customer Management Yes 
Electronic Claims Yes 
Forms Management No 
Paper-Based Claims Yes 
Payor Management Yes 
Policy Administration Yes 

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