Increase capacity by augmenting your staff to focus on the highest priority transactions and reduce manual workload.
Enable instant detection and resolution of coding anomalies, addressing abuse and payment issues, while obtaining proactive insights to guide and align health plan design with leading clinical trends, ensuring the highest value of care for members.
Uncover connections between actions and outcomes, influencing both positive and negative results. Identify corrective measures and leverage predictive analytics to anticipate the future impact of implementing changes.
Ventanas’ flexible platform framework is designed to tackle the most critical payor challenges
Surging healthcare transactions, including claims and appeals, is driving up costs due to manual processes. COVID-19-related deferred care is adding complexity.
Insufficient capabilities hinder continuous improvement in chronic disease treatment reimbursement alignment with prescribed regimens.
Limited transparency hampers the identification of cost drivers resulting from negotiated partner contracts deviated from industry competitive benchmarks.
Poor transparency impedes the assessment of operational program effectiveness, including case management, wellness enrollment, and preventative care outreach.
Increased call center demand raises staffing costs, extends response times, and results in member dissatisfaction.
Inadequate transparency regarding provider network performance and value, making it challenging to identify high-value clusters of care.
Actionable insights guided by nationally recognized data scientists, clinicians, and payer operators
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