OREANDA-NEWS. October 16, 2012. McKesson has introduced McKesson Reimbursement Manager™, an advanced claims pricer, to help health plans administer more complex reimbursement strategies — for example, combinations of fee for service and newer models such as bundled payments for episodes of care — while reducing administrative costs and increasing payment accuracy. This capability is a critical success factor for plans as healthcare transitions to new care delivery and reimbursement models that recognize value over volume, reported the press-centre of McKesson.

“Legacy claim systems can have tremendous difficulty sorting out which medical, payment and provider contract policies apply to a given claim when relatively straightforward fee-for-service payments are involved,” said James Evans, vice president, financial and network management, McKesson Health Solutions. “With McKesson Reimbursement Manager, health plans gain the flexibility to develop, reinforce and benefit from even the most intricate reimbursement combinations, all while keeping administrative costs low and payment accuracy high through greater automation.”

McKesson Reimbursement Manager helps health plans create, centralize and optimize provider reimbursement arrangements. The advanced pricer supports a combination of different reimbursement models by identifying the correct provider reimbursement rate based on member, product, provider, service and client-specific attributes.

When McKesson Reimbursement Manager is used in conjunction with two additional solutions from McKesson —McKesson Provider Gateway for provider and contract selection transactions and ClaimsXten™  for advanced claims editing — health plans can automate the entire reimbursement lifecycle. Together, these products help simplify provider reimbursement into a single, integrated process that calculates the appropriate allowed amount during claims adjudication by applying the correct medical, payment and reimbursement policies. These can be contract-specific or standard health plan policies.

“Without the appropriate infrastructure in place to keep policies in alignment, health plans will find it increasingly difficult to effectively compete in such a dynamic marketplace,” Evans concluded.