McKesson Introduces Advanced Claims Pricing Technology

McKesson Reimbursement Manager Supports Pricing for Complex Reimbursement Strategies

McKesson has introduced McKesson Reimbursement Manager, an advanced claims pricer, to help health plans administer more complex reimbursement strategies — for example, combinations of fee-for-service and newer models such as bundled payments for episodes of care — while reducing administrative costs and increasing payment accuracy. This capability is a critical success factor for plans as healthcare transitions to new care delivery and reimbursement models that recognize value over volume.

“Legacy claim systems can have tremendous difficulty sorting out which medical, payment and provider contract policies apply to a given claim when relatively straightforward fee-for-service payments are involved,” said James Evans, vice president, financial and network management, McKesson Health Solutions. “With McKesson Reimbursement Manager, health plans gain the flexibility to develop, reinforce and benefit from even the most intricate reimbursement combinations, all while keeping administrative costs low and payment accuracy high through greater automation.”

McKesson Reimbursement Manager helps health plans create, centralize and optimize provider reimbursement arrangements. The advanced pricer supports a combination of different reimbursement models by identifying the correct provider reimbursement rate based on member, product, provider, service and client-specific attributes.

When McKesson Reimbursement Manager is used in conjunction with two additional solutions from McKesson —McKesson Provider Gateway for provider and contract selection transactions and ClaimsXten  for advanced claims editing — health plans can automate the entire reimbursement lifecycle. Together, these products help simplify provider reimbursement into a single, integrated process that calculates the appropriate allowed amount during claims adjudication by applying the correct medical, payment and reimbursement policies. These can be contract-specific or standard health plan policies.

“Without the appropriate infrastructure in place to keep policies in alignment, health plans will find it increasingly difficult to effectively compete in such a dynamic marketplace,” Evans concluded.

For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue (http://mhsdialogue.com/), and follow us on Twitter at @McKesson_MHS (https://twitter.com/McKesson_MHS), or join our LinkedIn group (http://www.linkedin.com/groups/McKesson-Health-Solutions-4509971?trk=myg_ugrp_ovr).

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About McKesson

McKesson Corporation, currently ranked 14th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit us at www.mckesson.com.