SANTRAX® PAYER MANAGEMENT

A web-based solution to measure, monitor, and provide Electronic Visit Verification™ for all home care providers

Santrax® Payer Management (SPM) leverages the integration of the plan-of-care, authorizations, eligible participants, and home care provider agencies (including self-directed caregivers) to ensure care is delivered in the home setting as authorized. Using a variety of technologies, the system captures caregiver arrival and departure times, location, participant and caregiver IDs, and tasks performed during the visit. Rules-based claims submittal increases compliance and claims accuracy, reducing inappropriately billed services. The result is improved oversight into HCBS program delivery, streamlined claims, and reductions in fraud.

Electronic Visit Verification™

Our powerful combination of patented solutions for visit verification is called our Assured Coverage™ program and includes:

  • Telephonic Visit Verification™ (TVV™) –TVV™ uses Automatic Number Identification (ANI) technology to validate telephone calls to log in and log out, recording time and location in real-time.
  • Mobile Visit Verification™ (MVV) – Real-time GPS technology, verifying caregiver location and visits via GPS enabled devices (mobile phones and tablets).
  • Fixed Visit Verification™ (FVV™) – Patented technology to verify visits when no landline or cellular service is available.

 

Claims Validation

  • Immediate, real-time verification of authorized services including documentation of caregiver identity, start and end of each visit, location of service delivery and the creation of an electronic claim.
  • Claims engine ensures ONLY claims that match the authorization are sent to the payer for adjudication; placing the burden on the provider to bill correctly the first time.
  • Claims engine can be applied prior to claims submittal or integrated with the payer system as part of the claims adjudication process prior to payment.
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Jurisdictional View/ Business Intelligence

  • Payers and the home care network share a real-time composite view of authorized LTSS within their jurisdiction.
  • Supports program transparency and tightens audit controls by providing access to home care services data to effectively audit providers and conduct extensive post payment reviews on aberrant claims.
  • Plan-of-Care and Point-of-Care data collection and reporting capabilities to efficiently and effectively collect quality metrics for community based LTSS.
  • Business Intelligence and dashboard capabilities allow you to drill down to a more detailed level, create ad hoc reports, measure performance against benchmarks and provide additional project evaluation analytics.