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The Neighborhood program began working with HealthEdge in 2009 when the organization discovered their outdated system was not going to be updated by the system’s contractor, said Jeff Meyer, director of information systems for Neighborhood Health Plan.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.