Offering Enables Health Plans, TPAs, Self-Funded Plans and State Medicaid Plans to Administer Episode of Care Benefit Plan Designs
BURLINGTON, Mass.--(BUSINESS WIRE)--HealthEdge®, provider of the only integrated financial, administrative and clinical platform for health insurers, and Remedy Partners, the nation’s leading bundled payment company, today announced a collaboration to deliver a transformational platform to the market, capable of administering an entirely new category of health insurance benefit plan based on episodes of care and bundled payments.
This innovative offering provides a turnkey opportunity for payers, large self-funded employers and third party administrators to underwrite, sell, and/or administer episodes of care-based commercial products. The platform may be offered as a part of a comprehensive business process outsourcing (BPO) package or as a standalone platform for customers to independently manage the administration of episode of care plans.
“Bundled payments and episodes of care are part of the new reality of value-based reimbursements today,” said Steve Krupa, CEO of HealthEdge. “They will become even more important in the future and we are pleased to partner with the leader in the field, Remedy Partners, on this innovative offering.”
“Remedy Partners and HealthEdge are putting our combined domain expertise together for the benefit of health plans, TPA’s and large self-funded plans,” said Carolyn Magill, CEO of Remedy Partners. “We are jointly empowering our customers to offer innovative benefit plans that achieve the price points of narrow network products, while preserving a wide range of provider options and choice.”
This program offers a highly configurable, best-in-class technical platform for end-to-end administration of episode of care benefit plan designs, including group/member enrollment and eligibility maintenance; medical claims processing (both episode and non-episode claims); prior authorization and medical review; customer support for employers, providers and members; provider network maintenance and reimbursement and premium billing.