PayerIndex provides a price transparency platform specifically for post-acute providers managing payer contracts. This software allows facilities to benchmark their reimbursement rates against local competitors and track Medicare Advantage payer enrollment trends. Users can verify rate accuracy across claims systems to prevent underpayments and identify contract gaps.
Funding
Funding not disclosed
Founders
Product
Problem
Post-acute care providers face challenges in accurately understanding and managing Medicare Advantage (MA) payer contracts, leading to suboptimal reimbursement rates and compliance issues. The complexity of MA contract terms and varying payer rates creates administrative burdens and hinders effective negotiation strategies.
Solution
Clariti provides a specialized software platform designed to offer clarity and control over Medicare Advantage payer contracts for post-acute providers. The platform centralizes contract data, enabling users to easily access and compare payer rates and terms. By providing market insights and benchmarking capabilities, Clariti empowers providers to optimize their reimbursement strategies and ensure adherence to contract stipulations. This leads to reduced administrative overhead and improved financial performance.
Target Audience
The primary customers are post-acute care providers, including skilled nursing facilities and home health agencies, seeking to optimize their revenue cycle management and contract performance with Medicare Advantage payers.
Features
- **Rate Clarity Module**: Benchmarks provider rates against local market averages and competitor data, providing a "Rate Grade" for each payer.
- **Terms Clarity Module**: Digitizes and analyzes MA contracts to identify unfavorable terms and extract key clauses, creating a shareable contract library.
- **Market Clarity Module**: Maps the expansion and utilization of Medicare Advantage in local markets, tracking enrollment and payer share county-by-county.
- **Documentation Guidance**: Provides actionable insights and best practices to ensure clinical documentation aligns with specific payer requirements, aiming to reduce claim denials.
- **Contract Negotiation Support**: Offers data-driven insights to support providers in negotiating more favorable terms with MA payers.
- **EHR Integration Connectors (Coming Soon)**: Planned functionality to integrate contract details directly into Electronic Health Record systems for seamless compliance.