Babel Health, Inc. — provider of the first fully integrated platform for risk adjustment encounter submissions — is pleased to announce that Highmark Health has implemented the Babel Health solution for their RAPS and EDPS submissions.
Highmark — the fourth-largest overall Blue Cross Blue Shield-affiliated organization, covering the insurance needs of 5.6 million members in Pennsylvania, Delaware, and West Virginia — partnered with Babel Health to improve workflow and program efficacy, align their data, increase their submissions, while continuing to maintain full compliance. Before Babel Health, Highmark utilized an in-house approach that required following multiple processes on separate information systems for EDPS and RAPS submissions.
“We had an ongoing need to advance processes to improve how we measure results,” explained Ziegler. “Real-time visibility into the data, balancing between RAPS and EDPS, and quick problem-solving is crucial to ensure accuracy and completeness of submissions.”
“The need to simplify our processes and better leverage our resources was the driving force that led to finding a solution that streamlines our submissions and continuously improves quality,” said Olga Ziegler, VP, Revenue Program Management at Highmark. With Babel Health, Highmark can work through RAPS and EDPS encounter submissions on the same platform. This eliminates the need for two systems with duplicate data.
The Highmark team also desired to improve performance. “We had an ongoing need to advance processes to improve how we measure results,” explained Ziegler. “Real-time visibility into the data, balancing between RAPS and EDPS, and quick problem-solving is crucial to ensure accuracy and completeness of submissions.”
The Babel Health solution gives Highmark’s risk adjustment team direct access to all pre- and postsubmission errors, a clear explanation of each error, and a state-of-the-art workflow tool to correct those errors — with no need to engage the claims vendor. No other vendor offers this level of transparency.
Highmark also wanted to ensure that claims didn’t end up in a “purgatory” where they were neither rejected nor accepted. “Eliminating these unknowns impacts performance and reduces operational expense,” added Ziegler. “Any lag in making corrections and confirming submissions is not acceptable. With Babel Health, we know the status of all our submissions and, more importantly, we can ensure all appropriate submissions are sent to CMS.” Babel Health’s primary focus is the submission process — the last line of defense before an encounter is uploaded to CMS. This was another key reason Highmark decided to adopt the platform.
“Unlike other vendors who offer a wide range of services, Babel Health is laser focused on full transparency of risk adjustment data submission management, versus other companies where the submission is a “black box,” said Ziegler. “As we see changes in regulations and the introduction of new products, it is crucial that we continue to improve the workflow and maintain compliance,” noted Ziegler. “Having a user-friendly system that enables accurate and complete data submission to CMS makes this possible.”
About Babel Health
Babel Health provides an innovative approach to the entire risk adjustment and encounter submission process for health plans. The company’s integrated SaaS transactional and data management platform provides health plans with full transparency and control of the underlying data for business insight and critical day-to-day business decision making across all lines of business. Unlike other solutions in the marketplace, Babel enables its customer to take control of an extraordinarily complex process and provides user-friendly access to the data in order to solve the business problems inherent to risk adjustment submissions. For more information, visit www.babelhealth.com.
About Highmark Health
Highmark Health, a Pittsburgh, PA-based enterprise that employs more than 35,000 people who serve millions of Americans across the country, is the parent company of Highmark Inc., a hospital system, and other businesses. Highmark Inc. and its subsidiaries and affiliates provide health insurance to more than 5.6 million members in Pennsylvania, West Virginia, and Delaware as well as dental insurance, and related health products through a national network of diversified businesses. Highmark Health’s other subsidiaries include an integrated delivery network comprised of eight hospitals, more than 2,500 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania; and an information technology business focused on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge, and integrated cloud-based platforms. To learn more, visit www.highmarkhealth.org.