2. BAAAS
Benefit Analytics as a Service
Subscription Based
Base Price of Population + Transaction Volume
Super Simple to Setup
Super Simple to Use (just drop X12)
Enables collaboration with customers
3. Just-Drop-It Processing
Simple Integration (Everyone already does this)
Drop 834 (member eligibility)
Drop 837 (claim)
Drop 835 (claim payment)
Simple and easy to configure Benefit Structure
4. Simple Integration
Three files have all the data we need
All payers can generate these files ($0
implementation and integration required at
customer)
Asynchronous processing of file types
Super quick and can scale out or in if necessary
Designed so no transactions fail
5. Benefit Analytics
Allow basic ‘queries’ to start with
What’s total cost of my population that received
acupuncture v. those who did not for one year
What’s total cost for 9 months before and after for those
who had a natural birth v. those who had a cesarean
Analyze data for other meaningful patterns
Hospital XYZ is billing 150% of your other hospitals
Trend Analysis for predicting future utilization
6. V1 Monetization Strategy
Monthly Subscription Based
Base of Total Population * Fixed Amount
(these come in the 834 files)
Plus Total Claims * Fixed Amount
(these come in the 837 files)
8. V1: Benefit Analytics
Accept Flat Files for Initial Setup
Payer Drops 834s
Payer Drops 837s
Payer Drops 835s
Allows Queries and Displays Graphs
Learns meaningful queries across customers
9. V2: Claims Pricing
Attempt to reverse engineer rules (aka edits)
Member responsibility
Provider contracts
Pricing schedules
Payer configures edits
Payer Drops 834s
Payer Drops 837s
Payer Picks up 835s
10. V3: Services Review Pricing
Based on Claim Pricing rules
Payer Drops 278 Request
Payer Picks up 278 Response
Charged per 278 Request Transaction
11. Potential Other
Transactions + Revenue
Member Correspondence
Inpatient + Outpatient Pricing
Claims Payment
Premium Billing
Capitation
Fraud Detection
12. Other Perks
Basic restful API against public data sets useful
for health care enterprise
CMS Pricing (Price for Service with geographic
multipliers)
NPPES Data (National Provider Database)
Grow the API over time, managing this for
enterprises is painful
