Healthcare Contract Management Software for Improved Revenue
ClearContracts™ for hospitals and ClearContracts™ Pro (for Professional Groups) are web-based applications designed to fit into a healthcare organization’s revenue cycle management plan. ClearContracts enables all types of healthcare providers to analyze overall contract performance, verify expected reimbursement, and enhance the financial profitability of new and proposed payer contracts. Unlike other software providers, Concuity offers an innovative combination of services and web-based technology to allow our customers to quickly gain control over payer contracts and help them to immediately recover lost revenue due to underpaid and denied claims.
Unlike large hospital information and practice management systems that cannot process complex contract terms, model contracts, and identify and track payment errors, ClearContracts allows users to analyze every single claim flowing through their systems, based on the complex terms of their contracts, including carve outs, high cost drugs, stop-loss, and many other payment methodologies.
“In less than 4 months, $1.37 million of underpayments had been appealed and $1.24 million of that actually collected. I have every reason to believe that we can increase revenues by $3-6 million annually using Concuity’s solution.”
—Mike Butler Chief Financial Officer, Providence Health System
As a result, ClearContracts improves contract performance and visibility while enhancing cash flow and profitability. ClearContracts™ includes modules to assist healthcare providers in any stage of the revenue cycle:
Calculation Engine
Payer contracts have increasingly complex reimbursement terms and formulas that can be difficult to monitor and manage. Healthcare organizations need the ability to determine exact expected reimbursement and contractual allowances for all payers.
At the heart of ClearContracts is a sophisticated calculation engine that applies expected payment rules to detailed charge codes, diagnoses, procedure codes, revenue codes, and patient demographic data in order to determine what should be paid on each patient account based on the contractual terms.
The ClearContracts calculation engine maintains and utilizes all contract information to enhance the analysis of profitability, utilization, and compliance. With ClearContracts, historical data is used to forecast the impact of "what if" scenarios and model potential changes in rates, volumes, costs, or charges to project gross revenue, contractual allowances, net revenue, total cost, and profitability of contract payers and services
Revenue Recovery
The ClearContracts revenue recovery module is a blend of sophisticated intelligence and workflow technology that significantly decreases the manual effort needed to follow-up and collect on amounts owed. The ClearContracts data repository brings together all available information regarding each patient claim - from electronic information to scanned images of paper documents via EOB Pro.
Collectors are able to work individual or groups of accounts, generate activity logs, and work through steps for best-practices based on specific account characteristics. The recovery module also provides in-depth management oversight of the collection process and results, and includes a reporting tool that can quickly uncover patterns, trends, and root-causes in collection issues and performance.
Contract Modeling and Negotiation
Equip contractors with the best information to optimize trade-offs and scenarios in the midst of the negotiation and to understand the value of the total agreement prior to contract execution. ClearContracts strengthens the negotiation position with payers using historical patient data within the database to easily see the impact that changing volume, cost, rate, or charges will have on contract profitability. By creating multiple "what if" scenarios using your contract data as a baseline, you can easily forecast gross revenue, contractual allowance, net revenue, total cost, and profitability of proposed payer contracts.
» learn more about ClearContracts features
