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
Electronic Visit Verification™

Our comprehensive Electronic Visit Verification™ with Assured Coverage™ offers multiple ways to verify visits have occurred including:

 

Claims Validation

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.
Jurisdictional View/ Business Intelligence
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.