Contract discovery and analytics for health care providers and payers.
Healthcare is a highly competitive and regulated industry. That’s why for providers and payers that are keen to ensure compliance, having visibility into their contracts is essential. Yet unless you’re able to automate the process, doing so across thousands of agreements is a tall order.
Healthcare providers have to manage high volumes of complex agreements with suppliers, the physicians who utilize their facilities, and with payers. The challenge is those agreements need to adhere to strict regulatory guidelines such as HIPAA, Meaningful Use, The Affordable Care Act, and Stark Law. Plus, they need to be trackable by various criteria, such as:
- Region and facility
- Rate tables and schedules
- CPT codes
- Non-standard language
It’s extremely difficult for providers to stay on top of their volumes of contracts, especially in light of M&A activity, disparate contracting systems, and changing rules and regulations. Conducting manual contract reviews are just too costly and time consuming.
As the number of claims healthcare payers face increase, so do the number of contracts they have to manage. Dealing with so many only exacerbates the core issues they must contend with, including:
- A lack of standard templates and mistakes due to manual keying
- Poor contract management and optimization processes
- The use of non-standard clauses and the modification of clauses due to differences across geographies and customers
- Compliance with The Affordable Care Act, HIPAA privacy and disclosure obligations, current ICD-10 codes, and miscellaneous states mandates
- Dramatic increases in M&A activity among payers
Healthcare payers also need to keep tabs on the provisions in their provider contracts for facilities, and service professionals, as well as the shift from static fee schedules to fees for performance and/or service bundles.
How Seal can help
Seal applies analytics to the information in your contracts, making it easy to search for, sort, review, and compare contract data.
For providers, Seal will:
- Locate and centralize contracts from across your organization
- Immediately extract and index over 50 pieces of contract intelligence, including terms, provisions, and clauses
- Adapt to your organization’s particular services, terms, language, and preferences to run deep customized analysis across large contract portfolios
- Find specific contract components including compliance with HIPAA rules and obligations as well as contracts’ use the proper ICD codes, data breach obligations, etc.
For payers, Seal will:
- Manage the contractual and operational risk associated with M&A
- Give you the intelligence to better comply with Stark Law, ICD-10 and Medicare/Medicaid contracting and billing rules
- Ensure understanding and compliance of obligations associated with protected health information and data breaches
- Ensure the correct use of service codes
- Effectively track negotiated payment terms and non-standard clauses