EXL Health, in partnership with REVELOHEALTH™, OneCareCost™

Price transparency that puts payers and providers on the same page, so providers and patients can know their exact payment at the point of care in real-time.

Take back control and create a seamless experience

For years, a lack of price transparency has caused pain for healthcare stakeholders, a problem largely derived from key players using different systems, methodologies, and rules. Historically, payers have used tools and systems necessary for claims adjudication and pricing whereas providers required solutions for billing and payment revenues. The cost of translating between these systems is extensive and triggers a cascade of downstream challenges. These include numerous middleware vendors and unnecessary expenses of collection through escalating claim denials and appeals, medical necessity errors, and multiple levels of payment responsibilities. These costs can further escalate through the fines and penalties for non-compliance to the new price transparency order and No Surprises Act.

These challenges arise when an estimated price is established without knowing the agreed-upon reimbursement rates set by the payer. Providers are left attempting to discern actual reimbursement amounts derived from the limitations of a managed care contract. Confusing edits, rules and algorithms that are not accessible to providers complicate the ability to accurately calculate the allowable.

Employers get caught in the middle, paying rising annual health plan costs without meaningful real-time information on which to make decisions. Third-party administrators and brokers maintain the status quo, with no incentive to remediate the situation. Worst of all, in an era where patient engagement and positive experiences are paramount to the healthcare system, the existing process results in dissatisfaction and hesitancy towards future involvement.

Current contract management and revenue cycle solutions are designed to mitigate downstream issues while none have sought to fix the problem at its genesis … until now.

EXL Health can make a difference

In partnership with REVELOHEALTH™ OneCareCost™, EXL Health allows providers to integrate the payer’s claim pricing technology at or before the point of care, allowing providers to know their exact payment – and patients to know their costs – in real time.

OneCareCost provides immediate price calculations using the same technology and intelligence as the payer, removing the reliance on reactive solutions focused on mitigating downstream issues created by inaccurate, historical-based price estimations or limited fee schedule interpretations. Our solution processes payer contracts in a dynamic environment, providing live up-to-date data and results, as opposed to relying on a static managed care contract load. OneCareCost accommodates for plan design changes, policy updates, payment rule changes, or any other surprises that may require updates to your active managed care contracts within the plan year.

OneCareCost illuminates hidden data, reveals the true price of care in real-time, reduces the cost of collections, and supports timely clinical and financial decisions that drive accelerated revenue recognition and a stabilized bottom line.

Let’s partner together to provide consistent data and a better patient experience

How it works

OneCareCost is a repricing engine with built-in analytics for determining specific pricing on an allowable procedure – down to the penny – based on the stated CPT/ DRG code at or before an episode of care. It federates claim data across provider systems via 837 and 835 file formats as part of the claims clearinghouse process. No specialized interfaces within systems are required.

Benefits include:

Immediate contract rate validation at the origin of service
Compliance with the price transparency order and No Surprises Act
Identification of underpayments and payer billing code changes not possible with historical payment analysis
Real-time reconciliation of Advanced Explanation of Benefits (AEOB) to reimbursement
A centralized database of value-based care information for incentives and compliance

By eliminating the problem at the point of care, providers will benefit through reduced costs, fewer denials, lowered staffing requirements in backend revenue cycle functions, and better transparency into underpayments and negotiated rate sheets.

Accurate

The product of a partnership between EXL Health and REVELOHEALTH, OneCareCost incorporates the combined resources and experience of both organizations in a powerful, integrated revenue cycle management solution that provides transparent insight into how the payer interprets your managed care contracts.

From day one, our provider clients expect a high level of accuracy through our integration of payer rate models, coding sets, and pricing modules, providing accurate AEOB insight for exact pricing at the point of care. Over time, the system “learns” your network, achieving nearly 100% accuracy. Each output from the OneCareCost solution is based on established payer allowable – down to each line item and translation of modifier, edits, and subset methodology. No other solution in the industry provides an equivalent.

Focus on improving the health of your community with advanced price transparency

Only OneCareCost combines best-of-breed A/R resolution, advanced revenue analytics and payment processing services to enable the insights, tools and support you need to optimize your business. Get up and running fast without ripping and replacing systems, hiring, and training new staff, all with minimal disruptions to your resources and workflow.

Start your journey now

Are you ready to drive the encounter, with accurate EOB pricing at the point of care in real-time? Protect margins, avoid litigation, analyze market opportunities, and deliver a more satisfying patient experience. With OneCareCost, your provider office can leverage the same technology as payers at the point of care.