Helping you manage risk
Centricity™ Financial Risk Manager offers comprehensive solutions for provider institutions, health plans, and accountable care organizations that manage partially or fully capitated risk-based contracts as a part of the journey toward value-based care delivery. The solution includes the following capabilities:
As the core of Financial Risk Manager, the Enrollment module collects demographic, insurance and enrollment data including employer, physician and benefit information. It enhances the enrollment workflow and supports a wide spectrum of user-defined benefit plans that can be linked to multiple employer groups.
The Referrals module simplifies task management and streamlines the workflow with automated referral queues and the ability to flag referrals based on rules, procedure or diagnosis codes, or other criteria as specified by your organization.
The Claims module automatically adjudicates claims entered manually or through Electronic Data Interchange (EDI). It enables you to manage a variety of reimbursement arrangements including withholds, discounts, per diems, RVUs, DRGs, and APCs, and facilitates streamlined processing of individual or groups of claims.
Capitation and risk management
The Capitation and Risk Management module helps you manage and administer reimbursement arrangements with primary and specialty providers. It enables you to track and monitor reimbursement to capitated providers and medical groups, as well as flexibly administer withhold and stoploss arrangements.
The Premium Billing module enables you to calculate and produce premium bills for employer groups and self-pay members, manage receivables, and administer broker commissions. You can flexibly negotiate rates with employers differentiated by member type, employer group, benefit plan and other variables.
The Case Management module supports your quality of care initiatives and helps you manage the cost of complex and high-risk episodes of care. It enables case managers to identify cases, track care plans, simulate costs of care under different scenarios, generate form letters and link multiple service records related to a single case.
The Customer Service module is a comprehensive call and task management system that enables you to respond to your customers’ needs quickly and easily. It enables you to capture data related to calls and correspondence, categorize and track issues, and calculate expected turnaround time.
Electronic Data Interchange (EDI)
Financial Risk Manager comes with standard EDI transaction sets that include Healthcare Claims (837), Healthcare Remittance (835), Referral Verification (278), Eligibility (270/271), Claim Status (276/277), Premium Payment (820), and Enrollment (834).