Solutions

Real-Time Adjudication: Having pioneered the first commercially-available pharmacy benefit management systems more than 20 years ago, Healthation's founders have successfully transferred their real-time system design expertise to the larger healthcare market. As a result, no other system is better prepared to meet the demands of fully-integrated and automated benefits administration at the points of decision, care, and sale. The entire market is now moving towards an interoperable 21st century retail delivery system. Retail is synonymous with real-time. Healthation is the only system built form the ground up for real-time adjudication across all lines of business.

Financial Management: Healthation is the only core administration system on the market with a dual-sided general ledger accounting system built into the framework of the application. This means that business users can configure complex financial transactions with unprecedented flexibility and automation. As healthcare administration becomes increasingly real-time and interoperable, core administration systems need to automate increasingly complex financial transactions such as settling a single claim against multiple internal and external funding accounts.

Transaction Management: As healthcare administration becomes increasingly real-time and interoperable, core administration systems need to do more than simply receive a transaction. New complex real-time interoperable use cases will require administration systems to negotiate multiple telecommunications and health industry protocols on multiple transactions that are spawned from a single request. ANSI, HL7, WEDI, CORE, NCPDP, Visa and other standards will need to be managed simultaneously. The rules for these transaction management use cases will need to be configurable and extensible. Healthation enables both.

Group, Member, Provider Management: Fully capable of supporting today's standard group, member, and provider functional requirements, Healthation also enables customers to innovate and prototype new business use cases in a transforming market. As the market transforms from a traditional fee-for-service system to one that is performance-based and consumer-centric, Healthation already enables the configuration of tomorrow's business of healthcare. For example, the emergence of accountable care and corresponding episodic care contracting models will require extreme levels of automation and integration. Healthation supports these future models today, with capabilities such as:

• Diagnosis-based benefit design across all lines of business
• Mixed capitation and fee-for-service contracts
• Time-based clinical step therapy across all lines of business
• Non-funded product and service processing
• Real-time Web service calls to external utilization data and
  performance indices
• Incident/Episode framework
• Automated proactive workflow events
• Value-based benefit designs

Customer Service: User friendly and interactive data views enable customer service personnel to quickly and easily respond to member, provider, employer, or other client configured constituent inquiries. Workflow embedded CRM functions seamlessly integrate customer service with other business operations. All system data is updated in real-time so CSRs are equipped with up to the minute information to respond to inquiries or provide claim, billing, payment, and other transaction status.

Portals: The Healthation self service Web portal solution enhances constituent connectivity with two-way interactivity between all the players connected to a payer or administrator: providers, members, employers, and agents/brokers in whatever combination is desired. Our customers' constituents can perform self-service transactions, download information, and work interactively with electronic health information. The Healthation portal decreases communication and service costs and has demonstrable ROI.

Reporting & Analysis: In addition to the nearly 150 parameter driven standard on demand operational reports that are included in our base system, Healthation has developed a Data Mart to support client ad hoc reporting and data analysis requirements. The Data Mart can be used with Microsoft SSRS, Analyzer^™ from Strategy Companion, or any third party business intelligence (BI) or reporting tool.

Benefit Plan Management: Healthation is architected for all lines of business (medical, dental, vision, disability, life, pharmacy, etc.) as a highly flexible, user definable rules-based system that drives all adjudication, billing, workflow, CRM, and other core system functions. Healthation enables clients to auto-adjudicate not just claims, but complex business processes as well. Healthation provides users with a simple yet extremely flexible user interface for business rule configuration and management. Rules components are highly reusable, making ongoing maintenance and database management/performance highly efficient.