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Hospitals can electronically CONNECT
to health plans to quickly coordinate care for patients at no additional cost.
Automate your managed care agreement requirements to increase efficiency and save time.
- Expedite payment of claims through immediate notification to health plans of why a member was admitted or seen in Emergency Department (ED).
- Comply with 24-hour notification requirements automatically. This process can replace the current inefficient use of staff time for paper copies,
phone calls and faxes.
- Reduce onsite health plan nurse or your staff time to collect information for case management or prior authorization purposes.
- Facilitate and support your Accountable Care Organization (ACO), episode-based payment initiatives and other shared savings/risk arrangements.
- Send timely discharge summaries to initiate efficient post-admission care support and minimize re-admissions.
Choose the clinical data you want to route and deliver in real time to any health plan participating in CliniSync.
CliniSync can use your existing interfaces to identify and route the information you choose to send to health plans based on the member’s eligibility
and/or the patient’s primary insurance information validated during the hospital encounter. This process can replace the current inefficient
paper, phone and fax trails.
Limit exchange to HIPAA-permitted uses.
Participating health plans agree to limit data to HIPAA-permitted uses for payment and health care operations as defined by law. Permitted uses
include billing, claims management, utilization review, identifying members for care management and improving the accuracy of HEDIS/STARs measures,
plus more.
Contact Peg Eichner, HIE Project Manager, for more information on Health Plan Services at peichner@ohiponline.org
