Medical Advices

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DARIEN, Ill., July 22 /PRNewswire/ — Healthation’s, next generation AboveHealth (AH) portal solution delivers a rules-based, claims-system-agnostic, real-time communication and administration to health plans. AH allows payers to manage web-based communication and transactions for both commercial and regulated lines of business in support of medical, dental, pharmacy, vision, life, and disability. AH offers highly customizable portals for Members, Employers, Providers, health Plans, TPAs, and Brokers. AboveHealth(R) enables users to streamline processes, increase productivity, and support regulatory compliance in one single solution.
AboveHealth’s Provider Directory is now updated to meet NCQA criteria, helping health plans to comply with NCQA accreditation standards. The NCQA, a non-profit organization focused on improving the quality of healthcare, has recently established standards and guidelines for managed care organizations (MCOs) in the areas of member rights and responsibilities as well as information and services available to members. Improvements to the Provider Directory include the ability for members to filter results to show only the member’s LOB and Network(s); view the providers’ specialties, certifications, and education; and view the facilities’ accreditations; and search for hospital and group affiliation.
AboveHealth now features provider scorecards that make provider ratings transparent for end users. President Bush’s August 2006 executive order mandates all health plans that administer benefits to Federal Employees must adhere to the 4 Cornerstones of Transparency: increase transparency in quality of care, increase transparency in pricing, encourage adoption of health information technology (HIT) standards, and create positive incentives that promote quality and efficiency in health care. The provider scorecards on AboveHealth’s Provider Detail pages supports health plans by allowing them to display the rating categories and scores that health plans generate from their own system. Provider rating areas include Member Satisfaction, Clinical Quality, and any other rating category the health plan determines. Both the criteria to determine the scores and how the scores are displayed can be tailored to meet the needs of the business plan, making the provider scorecard highly configurable.
AboveHealth rolls out new Member Interventions feature. Member Interventions is a tool providers use to view procedures that the health plan recommends be performed within a specific period of time. health plans define the ‘measure’ and the ’steps’ to be considered by the member’s physician and AboveHealth displays the resulting intervention request. When this feature is turned on, the intervention status appears at key locations on member based pages, signaling whether or not the member has active interventions for consideration. Clicking the status takes the provider or member to the member’s Intervention List where all measures and steps in effect as of the current or specified search date can be viewed.
About Healthation — Darien, IL- based Healthation is a healthcare claims processing and portal solutions software company helping health plans, third party administrators and self insured employers improve business performance with user-driven, rules-based, open architected, benefits management and transaction processing solutions. Healthation’s goal is to accelerate a retail transformation in healthcare with a real-time, open exchange platform. Healthation offers two industry leading products to the payer industry. The AboveHealth solution is a next generation claims-system agnostic, rules-based portal and AcceleHealth(R), the industry’s only web-based payer system built to administer benefits in real-time across all lines of business under one master member record, including medical, dental, vision, pharmacy, life, and AD&D.
Healthation