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SOLUTION BRIEF
IBM Treatment Cost Calculator Consumer solutions for provider
As healthcare benefits are redesigned, health plan members assume a larger portion of the costs. This presents a challenge to your providers as they work to collect payments. The Treatment Cost Calculator from IBM Watson Health™ helps providers set expectations and collect payment before providing services.
Improved provider relations
Health plans can now support their providers with a tool that clarifies the expected treatment cost, as well as a patient’s personal liability based on covered benefits, remaining deductible and other information. The Treatment Cost Calculator helps health plans answer questions such as:
– How can we provide accurate, timely information about patient liability to providers?
– How can we make the cost of treatment more visible and easy to understand?
– How can we help providers collect from patients, shorten or remove the revenue cycle, and ease their administrative burden?
– How can we improve provider satisfaction?
Benefits – Reduces surprises with highly
accurate estimates of patient liability
– Improves provider relations by addressing the issue of everincreasing bad debt
– Delivers a lower-cost solution with a higher degree of provider acceptance than real-time adjudication
– Allows IT staff to focus on mission critical systems
Features – Provides estimates for thousands
of services in office, outpatient facility, and inpatient hospital settings
– Generates highly accurate estimates that are specific to the provider and product line
– Personalizes estimates based on the patient’s current benefit coverage and status (e.g., deductibles, out-of-pocket limits, etc.)
– Flexible integration options for incorporating the tool into a provider’s workflow
Personalized estimates to support more accurate
time-of-service payment
Timely, accurate, personalized estimates
The Treatment Cost Calculator provides highly accurate real-time estimates of anticipated out-of-pocket costs for provider services. Our estimation models mine a health plan’s paid claims data to determine the likely payment the provider will receive.
The Treatment Cost Calculator estimates are personalized based on specific information, such as remaining deductible, out-of-pocket limits andcoinsurance. With these estimates, health plans can empower their providers to appropriately plan for their healthcare payments.
Accurate estimation versus real-time claims adjudication
Although real-time claims adjudication is a desirable goal, it requires extensive investment in claims payment systems as well as changes to provider workflow. And real-time adjudicationsolves only part of the problem. It functions well with simple services in the professional setting, but is far less effective with more complex, high-cost services such as MRIs, CT scans, outpatient surgery and inpatient admissions delivered in the facility. Accurate estimation is a better means ofaddressing these variables.
An important breakthrough in consumer-driven healthcare
The Treatment Cost Calculator provides a simple, easy-to-use interface with few inputs, making it well-suited for busy front-office clerical staff and others not familiar with the information requiredfor submitting a claim. The tool can be used as a complete strategy, or it can supplement a real-time adjudication approach.
The Treatment Cost Calculator is designed as a web service and can be integrated into the provider workflow with links to the eligibility verification process (e.g., a payer-provider portal or clearinghouse). By helping providers proactively manage their patients’ plans and expectations, the Treatment Cost Calculator represents an importantbreakthrough in consumer-driven healthcare.
The Treatment Cost Calculator is part of Watson Health’s consumer engagement suite of solutions:
– Treatment Cost Calculator for Providers
– Treatment Cost Calculator for Consumers
– IBM Benefits Mentor with Watson
– Watson Assistant for Health Benefits
Our consumer engagement solutions empower individuals to become actively involved in managing their own health for higher satisfaction, better overall health and lower medical costs.
Simple, easy web service that integrates with existing workflow.
© Copyright IBM Corporation 2018
IBM CorporationSoftware GroupRoute 100Somers, NY 10589
Produced in the United States of AmericaNovember 2018
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Email [email protected] Visit ibm.com/watsonhealth
About IBM Watson Health
Each day, professionals throughout the health ecosystem make powerful progress toward a healthier future. At IBM Watson Health, we help them remove obstacles, optimize efforts and reveal new insights to support the people they serve. Working across the landscape, from payers and providers to governments and life sciences, we bring together deep health expertise; proven innovation; and the power of artificial intelligence to enable our customers to uncover, connect and act — as they work to solve health challenges for people everywhere.
For more information on IBM Watson Health, visit ibm.com/watsonhealth.
