Infogix, Inc., a developer of software that helps businesses automate the monitoring and analysis of operational data, today announced that Healthfirst, a not-for-profit managed care organization offering health insurance to individuals and families living in the New York metropolitan area, has invested in the Infogix Cost Sharing Reduction Solution to accurately forecast important financial formulas under the Patient Protection and Affordable Care Act legislation while also ensuring the integrity of all data involved.
Under the legislation, insurers and payers must annually reconcile the Cost Sharing Reduction (CSR) data with the government to determine their CSR reimbursements. The Cost Sharing Reduction Solution of Infogix allows companies to conduct that reconciliation while providing data integrity and visibility into the overall management of the cash flow. Healthfirst turned to Infogix for the following capabilities:
Forecast and determine the difference between actual cost sharing for the member and the cost sharing under the hypothetical applicable plan;
Capture source data from various sources requires to calculate the difference;
Map claims and claim lines to plan information and benefits information;
Calculate CSR amount
Manage discrepancies identified during reconciliation
"In this new world of health care reform, there are myriad complexities to the legislation and the processes, and if you're not on top of all of it, it can make a huge financial impact," said Robert Ruocco, VP, Information Systems, Healthfirst. "We ultimately made the decision that investing in the quality of the Infogix Cost Sharing Reduction Solution just made the best business sense and will, at the end of the day, protect our members, for whom the legislation was intended to help."
The Infogix Cost Sharing Reduction Solution for Healthfirst will include automated and customized controls, government advanced payment monitoring, detection of missing or out-of-balance payment, monthly forecast on expected vs. actual reconciliation reports and charts, and centralize dashboards of all CSR-related metrics.
"The Affordable Care Act legislation is terribly complex, in both its language and in its application, so insurers and payers are looking for either answers or reassurance that everything will go according to plan," said Sumit Nijhawan, CEO of Infogix. "Healthfirst is taking a bold step as a leader in the industry as one who ensures that their Cost Sharing Reduction expectations are accurate through protection and interpretation of the data. We know both the company and their members will have a smooth transition into reform because they've gone the extra mile to prevent damaging errors and miscalculations."