Case Management
HomeRun features extensive Case Management
and Third Party Administration capabilities. In addition
to being able to manage Fee For Service contracts
with HMOs, commercial plans, large and small group
health plans, and employee groups, HomeRun customers
can also manage risk-based capitated contracts . Eligibility,
policy thresholds and authorized services are used
operationally to integrate the patient referral, utilization
management and provider claim adjudication processes.
HomeRun enables users to define payer-provider and
payer-physician networks, while providing for both
contracted and negotiated rate billing and remittance.
The HomeRun Case Management Billing System features
an industry exclusive prebilling audit process that
adjudicates provider claims and encounters, flagging
billable items ahead of time that would be denied
by the pay plan. Other features include electronic
referrals, eligibility tracking, electronic provider
authorizations, extensive operational and management
reporting, statistical reporting, with standard cost,
pricing and future pricing capabilities.
HIPAA is built in, not just a bolt-on.
HomeRun Case Management allows the customer to do
business and operate in a completely HIPAA compliant
environment. Code sets, including CPT-4 and HCPCS,
are embedded within the Referral and Authorization
processes rather than being translated. Already supported
for existing customers, the ANSI X12N 278 Authorization
transaction feed provides for EDI interface of utilization
data with participating pay plans. HomeRun is fully
operational concerning the 837 Claim and 835 Remittance
Advice transactions.
Authorize Multiple Lines of Business
• Traditional HomeCare
• Parenteral Infusion
• Enteral Infusion
• Durable Medical Equipment
• Respiratory
Centralized Contract Management
• Capitated
• Fee For Service
• Pass-Through
Network Referrals
• By Town
• By Provider
• By Pay Source
Authorize Vendor Services
• By HCPCS
• By Clinical Service
• By National Drug Code/Prescription
Claim Processing and Adjudication
• Authorization Billing Audit
• Bill the Pay Plan
• Remit to Provider
HIPAA Compliant Code Sets and
Transactions
• ICD9-CM
• HCPCS
• National Provider ID
• ANSI X12N 278 Authorizations Feed
• ANSI X12N 837 Claims and Encounters Feed
• ANSI X12N 835 Remittance Advice Feed
