The extended platform addresses practices that influence Medicare-eligible or Medicaid-eligible consumers into enrolling in ACA marketplace plans to increase reimbursements. The Equity solution identifies and classifies payments based on certain characteristics. Should a payment not meet a payer’s criteria or match a previous accounts receivable invoice, the payment will be pended for review.
“While the concept of third party payments may not seem harmful at first, the reality is that third parties are paying premiums for low-income high-risk patients for the sole purpose of obtaining higher reimbursement rates,” Eugene Sayan, founder and CEO of Softheon, said in a prepared statement. “This not only impacts payers’ bottom lines, but it also disrupts the risk pool and increases the cost of care for everyone.”
More articles on payer issues:
Aetna executives take witness stand, Blue Cross of Idaho names CFO, UnitedHealthcare unveils bundled payment — 11 payer highlights
Fairview, BCBS of Minnesota settle contract dispute
American Diabetes Association opposes ACA repeal without immediate replacement
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