The healthcare industry is shifting from fee-for-service toward value-based payment models. This shift challenges healthcare payers to more efficiently manage member care and deliver cost savings — all without compromising on quality.
Capture quality encounter and clinical data
Identify other health insurance coverage
Manage your members’ identity and social risk factors
TransUnion Healthcare offers revenue protection and data integrity solutions to healthcare payers, including:
Identify potential first-in-line insurance coverage for your member claims. Our OHI Discovery solution — offered to payers and cost containment vendors — leverages TransUnion’s proprietary data assets to discover previously unknown coverage. Findings are verified as active for the date of service ensuring only viable, high-quality results are returned. As a result, you can recover payments for incorrectly paid claims and improve your coordination of benefits process.
Improve the quality and timeliness of encounter data received by healthcare providers and reported to regulatory agencies. Our Encounters and Claims Management solution ensures data integrity by validating and applying edits to inbound encounter and claims data in advance of reaching your IT system. Our expert data team works to ensure providers correct rejections using our industry-leading web portal, and TransUnion Healthcare’s proprietary reporting and analytics gives your organization complete insight into the status of submitted and rejected transactions.
Find missing clinical data to improve clinical outcomes and increase provider connectivity. TransUnion Healthcare’s Clinical Data Clearinghouse solution —through our extensive network of data connections — transmits hard-to-format clinical and supplemental administrative data from laboratories, physician offices and various clinical databases. This data is delivered in an easy-to-digest format making it immediately actionable.
Identify and address social factors that impact health to make smarter population health management decisions. TransUnion Healthcare’s Social Determinants of Health solution —available to payers and cost containment vendors — delivers the industry’s most powerful and relevant datasets to help identify members most at risk of over or underutilizing healthcare services. When combined with claims and clinical data, these datasets have useful applications for risk stratification, predictive modeling and care management — leading to better health outcomes and lower costs.
Engage members and effectively coordinate care by updating outdated or missing contact information. Our data-driven Member Identity Management solution helps ensure accurate member information. Our databases contain information on over 95% of the U.S. population including over 13 billion unique name and address combinations and 4 billion telephone records, to ensure you have optimal contact information to reach your members.
Stay compliant with a HIPAA-compliant EDI process to interact with providers and regulatory agencies. Our EDI solutions support all types of healthcare transactions, including encounters and claims (837P, 837I, custom formats), insurance eligibility (270/271), acknowledgments (999/277U), claim status inquiries (276/277), ERA (835), healthcare provider information (274) and prior authorization (278).
Maximizing Medicare Reimbursement: Understanding the Three Types of Medicare Bad Debt
Discovering Missed Health Insurance Coverage: The 3 Most Common Types
Reducing the Adverse Impact of Medicare Audits: The Importance of Getting it Right the First Time
Validating Comprehensive Insurance Discovery Against New, Internal Processes and External Vendors