Neighborhood streamlines billing with HealthRules

GAINING AN EDGE: Jeff Meyer, director of information systems for Neighborhood Health Plan of Rhode Island, and Shirley Lopes, clinical coordinator, look through some files on the HealthEdge software. / PBN PHOTO/MICHAEL PERSSON
GAINING AN EDGE: Jeff Meyer, director of information systems for Neighborhood Health Plan of Rhode Island, and Shirley Lopes, clinical coordinator, look through some files on the HealthEdge software. / PBN PHOTO/MICHAEL PERSSON

The Neighborhood Health Plan of Rhode Island is the state’s first health care management business to team up with Burlington, Mass.-based HealthEdge to streamline its client billing through HealthEdge’s patented HealthRules product. It’s also the largest of HealthEdge’s 11 clients.
“Basically this … completely automates payer operation so everything from their enrollment, to how you enroll with them, their billing, their customer service, and all of their claim processing” is covered, said Ray Desrochers, HealthEdge executive vice president for sales & marketing. “So when you go to health care providers and you have a physical and some test done and some blood-work, all of those things generate claims and those claims go to your pay organization and the dream is that they can pay them in an automated way.
“It’s the most cost-effective option method out there and our technology … automates all of the other interactions,” he said.
The Neighborhood program began working with HealthEdge in 2009 when the organization discovered their outdated system was not going to be updated by the system’s contractor, said Jeff Meyer, director of information systems for Neighborhood Health Plan.
“Anytime you enter into a major project like this, you can’t always get the requirements and definitions down clearly up front,” said Meyer. “It’s partly a journey. So what we saw was a company that had a great foundational product and who could be a good partner on this journey.
“Our first day up and running was Oct 17. We literally went home on a Wednesday and by Monday we were completely connected and set up with the new system,” Meyer said.
Providence-based Neighborhood Health Plan, founded in 1994, is a nonprofit health-management organization that partners with community health centers and helps provide access to health care.
The organization contracts with the state to administer the RIte Care and Rhody Health Partners programs, and serves 67 percent of Rhode Island’s Medicaid managed-care participants. HealthEdge, a seven-year-old company, provides a modern, enterprise-class software platform for health care payers.
Both organizations last month announced completion of the three-year effort to transfer the Neighborhood Health Plan into HealthEdge’s software program. (Neighborhood Health Plan would not disclose the dollar amount of the effort.)
The HealthRules product will allow Neighborhood’s frontline staff to quickly and easily configure the system to meet demands, rather than rely on the information-services department to make the changes for them, Meyer said. HealthRules also provides Neighborhood with new functionality that may be used to support business growth as a result of health care reform and other changes in the marketplace, he said.
Neighborhood has already begun processing claims at a faster rate through HealthRules, which will enable them to re-engineer business processes and become more efficient, Desrochers said.
HealthEdge was chosen from six vendors.
Neighborhood chose HealthEdge’s HealthRules product because it was determined to find a new system with the flexibility and scalability to respond to new opportunities available through health reform and also find a partner with a strong commitment to customer service. “We saw a company that had a very, very exciting and unique product offering. It met our needs,” Meyer said. “We knew that it would need some tailoring because we were the largest customer they had at the time. But we saw a young company that was willing to work with us.”
Mark E. Reynolds, CEO of Neighborhood, lauded the new software platform.
“The speed with which we now can adapt and the additional functionality we now have will be important as we look to serve our current and new populations,” he said. &#8226

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