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Bundles Administration

The transition to a prospective bundled payment model creates new operational demands. Using standard ANSI transactions allows a seamless integration of different financial and operational systems with minimal impact to current revenue cycle processes, including those of different providers and payers. This integration, including full data security and HIPAA controls, is an essential element of our value-based care solutions.

The bundles administration platform identifies and consolidates multiple fee-for-service claims into a single bundle and then sends it electronically to a payer for payment. When the bundled payment is received, it automatically allocates and distributes the payments to each episode provider, including managing associated reserve funds.

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Progressive Services to Ensure Sustainability

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Provider Credentialing

Cedar Gate offers full credentialing services, including the initial intake of documentation, a comprehensive file review with primary source verifications, and submission of completed files to the payers. We also offer consulting services for delegated credentialing programs.

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Provider/Payer Contracting

We can assist you in contracting and contract administration in value-based programs. Throughout the pre- and post-contracting processes, Cedar Gate provides ongoing provider education through the development of reference materials and the facilitation of Q&A sessions in meetings with providers.

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Network Development

We work with you to screen and select high-performing networks to include in your fee-for-value program. Each high-performance network is evaluated based on parameters such as cost efficiency, quality, loyalty, and other client-specific objectives.

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Patient Experience and Engagement

Cedar Gate supports the patient onboarding process from initial inquiry through registration, enrollment, and payment. Our multi-pronged approach combines consistent communication, education, documentation, and technology to provide both patients and providers with the information necessary to ensure coordinated, end-to-end program navigation.

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Provider Engagement

We develop communication strategies grounded in provider performance data to offer practice transformation recommendations and training for provider relations, Medical Directors, and other staff.

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Bundled Program Marketing and Expansion

Cedar Gate works with clients to develop key messaging, customized presentations, and other materials needed to convey the value proposition to payer and employer audiences and to ensure continuous growth of the bundle program.

Incentive Pool Management & Payment Distribution

Benefit from established best practices and automated management for any risk and incentive pool scenario. Our administration system also fully automates payment distribution received to providers participating on any episode of care program.

 

Cedar Gate has deep experience and established best practices for the management of any incentive pool and provider payment distribution scenario that:

Aligns the interests of providers

with pre-defined, fixed payments with a focus on budget, mitigating the fee-for-service mentality.

to look ahead on how to maximize use of available resources, with a focus on reducing variability and costs.

to determine who provides the best value for patients, thereby improving outcomes.

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Serving

payers

Payers

Manage risk more effectively and obtain greater value for every healthcare dollar.

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providers

Providers

Act on emerging opportunities to transform operations and improve financial performance.

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employers

Employers / ASOs

Recognize high-value innovation opportunities in healthcare with our help.

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Discover More

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Client Press Releases

Vanderbilt University Medical Center Creates MyHealth Bundles, Providing Innovative Options for Employee Health Coverage

Vanderbilt University Medical Center Creates MyHealth Bundles, Providing Innovative Options for Employee Health Coverage

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Case Study

A Large Employer’s Center of Excellence Program Delivers 20 Years of Successful Outcomes

As one of the largest employers in Texas, this company pledged to change the experience for employees…

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White Paper
White Paper

Successful Bundle Payment Programs Unite Payers and Provider

The traditional fee-for-service reimbursement model has caused a deep-seated mentality…

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SOLUTIONS

Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.

Enterprise Data Management

Capture, organize, and utilize all valuable data sets securely and easily.

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Empower your team with timely information to take action and reach performance goals.

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Transform the way you report on your business with these intelligent tool sets.

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Support medical management activities across the care continuum.

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Manage patients effectively from chronic conditions to transitions of care.

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Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.

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Extend your effectiveness with managed, professional, or advisory services.

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