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Bundles Adjudication

Billing, collection, and payment workflows designed specifically for the comprehensive adjudication of prospective bundled payments.

Comprehensive Prospective Bundles Adjudication

Our Bundles Adjudication application features financial claims data integration and turn-key capabilities for billing, collection, payment calculation and distribution. Leveraging industry standard claims processing methods and protocols ensures minimal impact on existing revenue cycle management tools and payer core administration systems. Unique automated capabilities include the capability to “unbundle” payments and issue reimbursements based on the contract; and the ability to configure how risk pool funds get allocated among providers.

Bundles Adjudication

Administer prospective bundled payment programs with automatic conversion of fee-for-service claims into a single, bundled claim. Automate subsequent unbundling, auto-adjudication, and lump sum payment. The application uses standard 837 and 835 transaction sets so there is no impact on the provider’s revenue cycle management system, or the payer’s system.

Incentive Pool Management

Streamline processes that manage the reserve “risk pool” fund and customize the distribution of funds to downstream providers, helping mitigate the fee-for-service mentality to positively affect provider performance.

Payment Processing

Auto-reconcile claims and consolidate the bill of bundles sent to the payer. The payer issues a lump-sum payment for the services provided into the risk-bearing entities account, which is then processed and distributed to the provider participants.

Bundles Configuration

Configure bundles on-the-fly with the software application and guidance from your Cedar Gate advisor. The tools enable flexible design to manage every possible nuance in a bundled payment agreement, and the capability to monitor and optimize clinical and financial performance at the speed of business.

Payment Technology

A new generation of payment technology tools is needed to manage today’s complex alternative payment models. Efficient, flexible, and proven, our core payment technology processing tools are purpose-built for value-based payment models. They simplify the contract management and adjudication process for complicated reimbursement structures, including bundled and capitated payment arrangements. Support for common and proprietary data exchange formats and robust interfacing capabilities ensures a seamless integration experience with existing systems and partner ecosystems.

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Serving

Payers

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

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Providers

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

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Employers / ASOs

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

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EXPLORE SOLUTIONS

The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you. Learn more today!

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