Contract Management

Managing multiple payer contracts and terms can be overwhelming for any organization. HEI’s Contract Management solution can assist with tracking and managing changes to payer terms and fee schedules. HEI’s rule engine utilizes the contract information configured to accurately predict insurance reimbursement by determining insurance coverage, contractual adjustments and patient liability.   In addition, it assists with flagging services that require pre-authorizations.

HEI’s Contract Management solution uses a token based rule engine that is flexible to be able to achieve the most complex payer requirements. A Token is a piece of data that is retrieved or calculated from the EHR system. Rules are configured by utilizing these tokens to form conditional statements.

When a request is sent to the Contract Management solution, the configured terms and rules are processed to determine the appropriate actions to be performed. These actions are processed to create such things as: estimates, claims, invoices, etc.

HEI Configuration Portal

The HEI Configuration Portal is used to maintain Contract Management, Claim Scrubbing, Claim Population and application preferences. Contract Management utilizes the HEI Configuration Portal to configure payer contracts, terms, rules and fee schedules.

Contract Module

In the HEI Configuration Portal this module allows for the creation and maintenance of a payer contracts. Contract terms can be added, maintained or inactivated from this module.

Rule Editor

HEI Configuration Portal’s Rule Editor module gives the ability to create “if-then” conditional statements to apply an appropriate action.   These conditions or rules can be linked to a contract term. The same rule can be applied to multiple terms or contracts.   Rules are built utilizing tokens from the token library or can be configured based on how your organization is capturing the necessary information.

Action Module

Actions are to be performed when all conditions are met.   Within HEI’s Contract Management application, actions can be used to create items such as: copayments, coinsurances, non-covered services and contractual adjustments based on fee schedules or percentages.

Fee Schedules

Fee Schedules allow for a price list to be imported, entered or maintained.   These fee schedules can be linked to an action to perform calculated insurance reimbursement amounts and contractual adjustments.