Claims in the Cloud

BAAASBenefit Analytics as a Service

Subscription Based

Base Price of Population + Transaction Volume

Super Simple to Setup

Super Simple to Use (just drop X12)

Enables collaboration with customers

Just-Drop-It Processing

Simple Integration (Everyone already does this)

Drop 834 (member eligibility)

Drop 837 (claim)

Drop 835 (claim payment)

Simple and easy to configure Benefit Structure

Simple Integration

Three files have all the data we need

All payers can generate these files ($0 implementation and integration required at customer)

Asynchronous processing of file types

Super quick and can scale out or in if necessary

Designed so no transactions fail

Benefit Analytics

Allow basic ‘queries’ to start with

What’s total cost of my population that received acupuncture v. those who did not for one year

What’s total cost for 9 months before and after for those who had a natural birth v. those who had a cesarean

Analyze data for other meaningful patterns

Hospital XYZ is billing 150% of your other hospitals

Trend Analysis for predicting future utilization

V1 Monetization Strategy

Monthly Subscription Based

Base of Total Population * Fixed Amount

(these come in the 834 files)

Plus Total Claims * Fixed Amount

(these come in the 837 files)

Road Map

V1: Benefit Analytics

V2: Better Claim

Processing

V3: Services Review

Processing

V4: Optimize benefits

V1: Benefit Analytics

Accept Flat Files for Initial Setup

Payer Drops 834s

Payer Drops 837s

Payer Drops 835s

Allows Queries and Displays Graphs

Learns meaningful queries across customers

V2: Claims Pricing

Attempt to reverse engineer rules (aka edits)

Member responsibility

Provider contracts

Pricing schedules

Payer configures edits

Payer Drops 834s

Payer Drops 837s

Payer Picks up 835s

V3: Services Review Pricing

Based on Claim Pricing rules

Payer Drops 278 Request

Payer Picks up 278 Response

Charged per 278 Request Transaction

Potential Other Transactions + Revenue

Member Correspondence

Inpatient + Outpatient Pricing

Claims Payment

Premium Billing

Capitation

Fraud Detection

Other Perks

Basic restful API against public data sets useful for health care enterprise

CMS Pricing (Price for Service with geographic multipliers)

NPPES Data (National Provider Database)

Grow the API over time, managing this for enterprises is painful