Streamlining Claims Processing and Contract Management
OmniBilling was created to replace a legacy claims processing application (McBee Global Pricing System) in use by the Johns Hopkins Health System Managed Care group. The application provides a management solution to the intricacies of bundled contracting. It is specifically designed to meet the contractual agreements with managed care organizations (MCO) while providing the ability to track cost and profitability of the program.
Bundled contracting is a healthcare payment model where the patient pays one fixed rate for all costs related to treatment. Operating challenges include screening admissions to identify bundled contracts, notifying provider offices of bundled contracts, and ensuring provider payments are not made until the plan receives payment from the managed care organizations.
The Johns Hopkins Health System Managed Care group uses this redeveloped and modernized application to process claims. The system also integrates administration’s need to monitor, report, and reimburse physician partners in the program.