DURHAM, NC – Imagine a medical bill that can be accurately rendered before the patient leaves the doctor's office.
Bloodhound Technologies is working toward that ideal with ConVergence Point, its newly released claims editing platform that aims to process single or multiple claims against a patient's history, complete payer policy customizations and millions of sourced clinical edits in less than a second.
"This allows us to take a process that used to be in the claims transaction system ... and move it up to the front," said Gary Twigg, CEO and president of the Durham, N.C.-based claims editing services and analytics provider. "It's more robust, more sophisticated."
"The technology now exists to have a completely adjudicated claim even before the patient leaves the office," he added. "That's in the future. We'll be there someday."
Developed with $14 million in financing, ConVergence Point draws upon a patient's complete medical history, payer rules and reimbursement policies and Bloodhound's 16 million sourced clinical edits to process claims in 350 milliseconds. The company also offers a pre-adjudication editing platform, allowing providers to identify operational efficiencies as well as identify overpayments and correct miscoded claims before submission.
Among the beta-testers for ConVergence Point was Senior Whole Health, a voluntary healthcare plan for low-income seniors in Massachusetts and New York.
"From the get-go, Bloodhound Technologies was able to take our data and immediately respond with a comprehensive analysis," said Mike Levoshko, the group's CTO, in a press release prepared by Bloodhound. "What's more, ConVergence Point is a three-dimensional system that lets you turn its edit rules on and off at any point. The fact that ConVergence Point can control and archive these rules dynamically is worth its weight in gold."
Twigg says ConVergence Point should not only help providers and their patients establish a proper medical bill in real time, but improve communications between providers and payers.
"Real time adjudication processes are important to support the emerging consumerism market, providing clear payment liability information to both providers and consumers," said Janice Young, program manager for payer research with Health Industry Insights. "Solutions that improve the consistency, transparency and timeliness of claims processing deliver a new level of accuracy that will lead to improved relationships among payers, providers and consumers."
