Download - Healthbus deck
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