How automating ROI improves payer relations

While payers and providers share the goal of delivering their members/patients high quality, affordable healthcare, the best ways to work together aren’t always clear. Historically, there has been a lot of friction between payers and providers as they operate in a complex system that is mired by time-consuming, manual processes; contracts with untenable turnaround times; and mounting paperwork. The good news: the friction is decreasing as providers lean into interoperability and find ways to efficiently collaborate.

Moxe Health works to bridge the gap between health plans and provider networks by digitizing release of information (ROI). Notably, this automation helps providers improve their relationships with payers in three key ways:

1. Accurate patient-member match rates
   Our 98% patient-member match rate ensures payers receive the data that they request, eliminating the need for follow-ups with HIM departments to chase down patient data and resolve accuracy issues. Our match rate is so strong because we’re systematically looking for identifiers in patient data which match the specific requirements of each payer.

2. Data is formatted exactly how payers need it to be

   Data is meaningful when it is usable. Payers are consuming data in a myriad of formats from various EHRs and providers. Moxe ensures that the data that payers receive is consistent and in the payer’s preferred format, regardless of EHR or provider.  Shared clinical data is available in standard and custom formats including FHIR, PDF, XML, and JSON to support a variety of payer use cases, including HEDIS^®, risk adjustment, payment integrity, claims attachment, and audits.

3. Faster turnaround times

   Typically, providers are contractually obligated to turn medical charts around within 30 days. With increasing volume and limited resources, HIM teams using manual ROI processes struggle to meet these stipulated deadlines.  By automating ROI, HIM teams no longer need to ask for extensions and miss SLAs. Moxe processes thousands of charts in a matter of minutes, which helps providers exceed payer expectations.

As payers increasingly demand access to timely, accurate, comprehensive clinical data to inform their payment and operations initiatives, providers need automated solutions that are secure, efficient, easy to use, and cost-effective. Moxe’s Digital ROI™ is helping providers across the country meet the needs of their payers while improving operations. 

One Moxe client, Riverside Health System, tried many fulfillment methods to address the increasing payer demand for medical records: in-house, outsourced, and hybrid. Despite their best efforts and various models, meeting the stipulated deadlines was becoming more and more difficult.

Read more about the value Riverside gained by working with Moxe and how it improved relationships with their payers in our recent client profile. Digital ROI™ helped their HIM team respond to over 50,000 requests – a volume that in previous years would have taken months to complete.