Value-based Payment Reconciliation Solution

Automate value-based payment reconciliation

A single source of truth value-based reimbursement platform combines existing analytics capability with a powerful reimbursement engine to complement existing claims-based payments. It integrates with your existing financial systems and processes with just a few clicks.

  • Improve FFV payment accuracy, transparency, compliance, and timeliness.
  • Automate the reconciliation process, with workflow capability for review and manual approval as appropriate.
  • Gain control of your value-based reconciliation data so you can determine which structures are effective.

Advanced Payment Platform (AP2™) is a comprehensive value-based payment reconciliation platform to capture accurate value-based reimbursements efficiently.

Streamline value-based reimbursement initiatives with AP2™, explicitly designed to automate the reconciliation process and help healthcare payers and TPAs/ASOs to gain control of data and determine which structures are effective.

Drive automation and accelerate value-based payment initiatives smoothly

Operationalize every phase of your FFV payment programs with AP2™. This value-based payment reconciliation platform combines existing analytics capability with a powerful reimbursement engine to complement the current claims-based payments.

Take control of an agile and automated platform

AP2™ lets you house all your non-bundled FFV payment programs in a single solution. It helps payers and TPAs gain control of their value-based payment reconciliation data to determine which structures are effective.

Ensure compliance and transparency with regulatory agencies

Our robust audit and automated retroactive algorithms will help healthcare payers, TPAs, and providers ensure compliance with regulatory agencies and external auditors robust audit trails. Generate transparent and compliant FFV payments with just a few clicks.

Manage bundled payments with AP2™’s agile analytics capability

Our end-to-end approach implements bundled payment methodologies to manage value-based reimbursements using a combination of analytics capability and a powerful reimbursement engine.

AP2™ scores the highest compliance rating in IDC’s review.

2017 IDC value-based reimbursement technology spotlight.

Source: IDC technology spotlight

 VBR Impact and Requirement Compliance
  • Embedded or Parallel Reimbursement Logic
  • Benefit Plan Management, Rating/Pricing
  • Network Management
  • Ubiquitous Workflow/Use Analytics
  • Contract Management, Provider Relations
  • Provider and Customer Servicing
  • Benefit Plan Management, Rating/Pricing
  • Member 360/Appeals/Financial Traceability
  • Bundled Payment

Why Advanced Payment Platform (AP2™)?

Drive cost and quality improvements, empower value-based strategies, improve Provider relations, and comply with FFV reimbursements with data-driven and technology-enabled automated solution.
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Retroactive Transactions

Accurate, on-time up to 100%

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Speed-to-Market

Increase speed-to-market up to 70%

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Errors

Decrease errors up to 90%

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Processing Time

Decrease processing time up to 80%

Automate the reconciliation process and improve FFV payment accuracy using automated value-based payment reconciliation.

Application Module

Our advanced payment platform can be molded according to your business. Select from our integrated modules that suites your business to address your pain points and maximize investments.
Improve claims management accuracy

Simplify configuration of FFV programs on a business user configurable platform

Configure your FFV programs at one place with intelligent decision support, eliminate repetitive data entry into Core-Admin and other systems, keep your claims system up-to-date, and automate the maintenance of your product configuration with .Claims
Auto-generate documents to meet regulations

Automate document generation and version management processes

Dynamically generate transparent and compliant FFV payments including pay-for-performance, shared risk/savings, partial cap, full cap, global payments, incentive/PCMH/care coordination, bundled payment from a single source of truth. Enable omni-channel re-use of the language and dynamically generate print-ready documents to meet regulations or share your information on web portals or through print with .Docs
Seamlessly share information across the enterprise

Automate the integration of key benefits data and documents into essential systems

Ensure your single source of truth is integrated everywhere across the enterprise. Seamlessly integrate with and from your technology ecosystem via ETL, Web API, batch files from various sources including membership, Provider, benefits, claims, analytics, financial using .Integrate

Expose your user-configurable data to standard reporting tools

Ensure your dynamic pristine data is integrated with your Master Data Management investments, generate real-time FFV transactions and support path breaking FFV programs using the relational database format and flexibly captures all types of VBR/FFV programs using .DataMart

Frequently Asked Questions (FAQ's)

Here are the most common, frequently asked questions about implementing automated value-based payment reconciliation solution and partnering with Simplify Healthcare.

1. What is Advanced Payment Platform (AP2™)?

Advanced Payment Platform (AP2™) solution enables health plans and TPAS/ASOs to automate value-based payment reconciliation. It combines existing analytics capability with a powerful reimbursement engine that complements existing claims-based payments. AP2™ allows payers and TPAs to house all non-bundled fee-for-value payments within one solution, dynamically match provider contract provisions with provider performance data to determine accurate risk-adjusted payments, and ensure compliance with FFV reimbursements.

2. What is value-based payment reconciliation?

Traditional fee-for-service (FFS) reimbursement contributes to the high cost of care that plagues the healthcare system today. FFS reimbursement rewards Providers for delivering services and fails to differentiate payments based on quality and value. Value-based reimbursement is designed to shift the basis of reimbursement from volume to value by incorporating incentives to improve financial and operational performance.

Payers, Providers, and governments have embarked on a journey to transform the healthcare payment system from one that rewards volume to rewards quality and value. Under the value-based payment (VBP) programs, payers/TPAs reward providers for reducing healthcare costs while maintaining or improving quality.

3. What are the challenges with manual payment processes?

Manual processes have a lot of issues that can be eliminated with an automated solution. Here are some of the biggest challenges with manual payment processing:

  • The Core-Admin system may not be able to handle value-based payment reimbursements efficiently.
  • Complex and manual value-based reconciliation processes and Excel spreadsheets are time-consuming and error-prone.
  • Lack of efficient processes to scale and grow value-based reimbursement arrangements.
  • The significant lag between Provider actions and incentive payments reduces the effectiveness of the value-based incentives.

4. How does Advanced Payment platform (AP2™) help payers and TPAs?

Advanced Payment platform (AP2™) is an intelligent value-based reconciliation system to reduce payment and data entry errors, batch processing timelines from an average of 18 – 24 hours to 4 – 6 hours. Here are some of the key features of the AP2™ platform:

  • Capture all of the attributes and rules of each FFV contract in a single source of truth.
  • Automate the reconciliation process, with workflow capability for review and manual approval.
  • Increase the frequency, timeliness, and transparency of payments and associated incentive data to providers.
  • Scale operations and achieve value-based payment reimbursements quality and financial goals.
  • Gain visibility across all segments and ensure FFV reimbursements with regulatory agencies and external auditors’ robust audit trails.
  • Improve provider relations with clarity on policies, transparency in payments, and prompt payments.

5. What are the benefits of automating your payment processes?

Healthcare payers and TPAs can now consolidate all the non-bundled FFV payment programs in a single automated solution. You would be able to integrate via ETL seamlessly, Web API, or Batch files to/from various sources and streamline payment processes. An automated claims payment processing platform like AP2™ helps incentivize the providers, build better relations to encourage Providers to offer better services to the members, gain transparency of data for the key stakeholders, and provide accurate payment outcome information.  With effective automation, payers and TPAs can dramatically expand the number of FFV contracts to realize value-based payments’ true benefits.

What our customers say.

``The value-based reimbursement system that was developed was not only functionally robust from an online perspective, but it also reduced batch processing windows from 18 – 24 hours to 4 – 6 hours. The amount of information that an end-user could view 'at-a-glance' greatly enhanced productivity. The sophisticated drill-down features helped streamline the plan's operational activities.``
VBR Program Manager
''We had exceptionally aggressive timelines to deliver and deploy a very complex payment reimbursement system. Simplify Healthcare met the deadlines, even as our customers continued to add requirements while we were in trial testing. Their team worked many nights and weekends to enable our Plan to go live on time.''
VBR Project Manager
``Simplify Healthcare's Advance Payment Platform (AP2™) is a value-based payment reimbursement system. It combines the payer's analytics capability with a powerful reimbursement engine that complements existing claims-based FFS payments. AP2™ is a modular solution that can be implemented in a phased manner per payer readiness. It is suitable for all lines of business, including commercial and government programs.``
IDC Research Analyst

Ready to get started with AP2™?

Are you interested in learning more about AP2™? Our team is ready to answer all your questions. Let’s make smarter health ecosystems together! Schedule a 1:1 demo with us today!
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