Specialty Services

Health plans must spend 80-85% of their premiums on health care costs and quality improvement measures. Consequently, plans have insufficient funds to make much-needed investments to their infrastructure, undertake modernization efforts, or implement government mandates.

Catalyst helps plans address medical cost reduction and revenue accuracy by using an intelligent data- driven process to identify probable targets of improvements. Through an integrated portfolio of services, Catalyst drives substantial and measurable annual cost savings. Additionally, this service lowers the plan's administrative costs and frees internal staff resources to focus on other value-added service.

Catalyst’s growing portfolio includes:

DME Spend Reduction

High Cost Pharmacy Cost Reduction

Member Disability Classification

Payment and Premium Accuracy Optimization

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EDI and Encounters Services

Many healthcare organizations have challenges managing EDI and encounters. Plans face administrative complexities and regulatory pressure, as well as, a constantly changing ecosystem of operating rules, standards and requirements.

Many plans utilize a hybrid collection of custom applications and third-party solutions. Catalyst can help bridge the technical and subject matter gaps to optimize existing technologies and improve operational performance.

Catalyst can help streamline a plan’s encounter management operations and improve first pass rates for managed Medicaid and Medicare Advantage. The goal is to utilize processes and technology that drive upfront business validations and reduce encounter rejections. Additionally, Catalyst works to ensure the client is tracking and managing the adjudicated claim-to-encounter lifecycle.

Moreover, Catalyst helps plans deliver complete and accurate encounter data submissions to their State Medicaid Agencies (SMAs), who pass this information along to CMS. Catalyst partners with plans to develop process and technologies to maintain their history of rejected encounters, data quality metrics and SLAs for individual MCOs.

Platform De-Hosting

Health plans need to ensure their technology is secure, controlled, cost-effective and highly available. Many vendors commit to delivering hosting and infrastructure management services that promise to keep the healthcare plan’s applications optimized and running smoothly.

But what happens when the vendor fails to deliver on that promise or the vendor becomes too costly?

At Catalyst, we partner with your technology team to plan the move back to on-premise or a hybrid solution. Catalyst offers:

  • Implementation and Project Management
  • Architecting Ancillary Software in all New Environments
  • Solution Architecture Guidance with Automated Deployments
  • Database Migrations
2353 S/b Broadway. Denver, Colorado. 80210
303-393-8818 | 800-903-9574 | 303-393-8838