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White paperdynamichealthcare

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  • 1. July 1 2010ProductOverview VoyagerThe information in this document is confidential and the propertyDynamic Healthcare Systems, Inc. Enterprise SoftwareSmarter Technology.Smarter Solutions.DYN-XX-201007
  • 2. Voyager Enterprise SoftwareVOYAGER ENROLLMENT AND MEMBER MANGEMENTThe Dynamic AdvantageDynamic is the leading enterprise software and solutions company for health plans that manageMedicare Advantage (MA) lines of business. Every MA plan depends on the accuracy,effectiveness and efficiency of their enrollment and member management group. TheVoyager® Enrollment and Member Management Modules provides the enterprise infrastructureand tools to Reduce Costs, Accelerate Revenue and Maintain Compliance Requirements.Smart CostsSince health plans are required to limit their administration costs, the Voyager® enterpriseapplication is designed to scale with a plan’s growth, without requiring additional full-timeresources. Voyager’s eligibility verification engine uses CMS’ recommended Batch EligibilityQuery (BEQ) and a set of auto-adjudication rules to quickly evaluate 98% of the elections anddetermine who should be enrolled, denied and require further review. Voyager’s eligibility andTransaction Reply Report (TRR) processing engines will allow for automatic member dataupdates and generation of required correspondence, reducing manual efforts, improving dataaccuracy and reducing compliance risks.Smart Revenue CyclePremium pressures and decreased processing transaction timelines require plans to accuratelysubmit and process transactions timely. Voyager’s data validations and compliance reporting isused to identify and eliminate ‘Avoidable Submission Errors’ to CMS, reducing errors, appealssubmissions and the CMS premium payment cycle. The Voyager Reconciliation module isintegrated with the Enrollment and Membership modules allowing for seamless and timelyevaluation of plan data and effortless correction of plan errors. Correct payment requires theplan to track and maintain an accurate view of their member’s demographic and special status.Voyager allows the plan to track every attribute including start and end dates to ensure accurateviews of the member for each payment month.Smart ComplianceVoyager is designed to ensure a plan stays in compliance with CMS enrollment policies. Theplan can assign and monitor required tasks using integrated work queues and workflows.Required correspondence is always triggered based on events and is easily accessed to reviewwithin Voyager. All changes to Election and Member information are stored with a detailed auditConfidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 2
  • 3. Voyager Enterprise Softwaretrail. Standard and customer reporting allows the plan to monitor tasks, turnaround times andcompliance risks. Voyager uses an enterprise role based security platform, allowing users toonly access the information that they need to perform their work, complying with HIPPA andSOX security and privacy requirements.Dynamic ServicesThe Dynamic solution recognizes that your success depends on a combination of superiorsoftware and service. Our team’s expertise in Medicare plan operations allows us to partnerwith customers to deliver the solutions they need when they need them. • Audit of Plan Enrollment Operations for Compliance and Best Practices • Mock CMS Enrollment Process Audit • Enrollment policy and compliance trainingIf your plan has been disappointed with previous vendors nickel and diming you for each call,email and question answered; or sold a bill of goods that does not exist; or does not reallyunderstand your challenges in your marketplace – Then it is time to call Dynamic HealthcareSystems.Voyager • Security: Role based security allows plan to meet their HIPPA and SOX security and privacy requirements. • Web Application: Voyager is designed to use the latest in JAVA and web based enterprise software technologies. Plan IT departments are largely un-effected by leveraging existing investments in hardware, software and user training. • Integrated Data Model: Voyager’s integrated data model allows Voyager modules to share data and provide a 360 degree view of the membership.Enrollment • Election Data Validations: Improve data quality using online data validation rules and real time U.S. Postal Service address validations • Correspondence Management: Manual and automatic letter creation and retrieval of historical letters • BEQ and TRR Processing: Automate actions based business rules for processing BEQ and TRR transactions.Confidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 3
  • 4. Voyager Enterprise Software • Integrated Workflow: Voyager’s integrated work queues ensure required tasks are assigned and completed. • Auto/Facilitated Enrollment Processing: Part D plans can process auto and facilitated enrollees in the plan. • Reporting: Standard and Custom reporting provides unlimited view of the your business Member Management • ECRS and COB Processing: Create ECRS submission files and process COB files to ensure accurate Part C and D COB data. • Complete Member Information: Store and maintain complete member demographic and special status information with start and end dates. • Integrated Reconciliation: Voyager Member data is shared with the Reconciliation module providing a direct view of the impact of plan data changes and correctionsConfidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 4
  • 5. Voyager Enterprise SoftwareRECONCILATIONMedicare Advantage health plansare required to attest that CMSpayment reports (MMR) are correctand accurate with their internalrecords. Dynamic’s reconciliationmodule allows a plan to easily loadtheir bid information and MMR andquickly identify member, special status and payment discrepancies.Focus On the Bottom Line • Idenitfy prospective payment and retrospective adjustment discrepancies • Member discrepancies are quickly identifed and sent to the enrollment group for resoluition • Special Status discrepancies are captured where corrections can be make to either plan data or appeals to CMS • Identify payment level discrepancies indicating issues with bid information or CMS payment processing errors.Resolve Discrepancies • CMS is Wrong – Send appeals to CMS to correct member and special status discrepancies • Plan is Wrong – Correct plan information in Voyager and recalculate payments to resolve internal data errors • Track Discrepancies to the Member Level – Voyager will track payment issues to the member level. Showing what payment calculations are discrepant with CMS.Confidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 5
  • 6. Voyager Enterprise SoftwarePREMIUM BILLINGManaging your Medicare Advantage and Part D billing has never been easier. This full-featured moduleintegrates up-to-the minute member subsidies and late enrollment penalties and complete tracking ofprospective and retroactive enrollment actions to provide simple, compliant billing and premiummanagement. • Calculate member premiums and refunds • Retroactive adjustments for enrollment/disenrollment activity • Reconcile SSA Premium Withhold • Invoices, statements and coupons, with re-prints • Manage SPAP and other third-party payors with split bills • Employer groups • Low income subsidies • Late Enrollment Penalties • Auto-draft/direct debit with pre-notes • Grace periods and late payment arrangements • Age outstanding balances and manage delinquencies • Trial bills • Customized GL exports • Lockbox remittances with automatic or manual allocationConfidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 6
  • 7. Voyager Enterprise SoftwareHCC ANALYTICSRisk Adjustment is far more than a data collection project… it drives your bottom line.A single missed diagnosis can cost thousands of dollars. HCC Analytics examines all source data toidentify suspect, missing or incorrectly coded diagnosis codes – the foundation of your risk adjustmentfactors.Target Suspects • Manage diagnosis data from a variety of sources – including claims data, pharmacy encounters, chart audits and more. • Detect suspect missing diagnosis codes from historical encounter data. • Store and report in a members HCC history • Calculate RAF scores based on varied collection and cut off dates • Quickly enter and validate updated diagnosis • Plan defined validation rules library • Member level suspect list of missing ICD9 codes and coding errors • Project future RAF scores • Substantial Report LibraryConfidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 7
  • 8. Voyager Enterprise SoftwareRAPS MANAGEMENTRAPS Management Module allows a health plan to import, submit and reconcile the submission of RAPSencounter data with CMS. • Contains a rules engine that validates data reducing rejections and resubmissions to CMS, reducing costs • Improves the quality of data submitted to CMS. Provides for manual entry of RAPS data • Validates and edits RAPS data before submission to CMS • Resubmits corrected RAPS data to CMS • Reconciles RAPS reply fields with submission files to the encounter level • Submits all RAPS data to CMS for Part C & Part D • Tracks, ages and provides management reports for data sourcing, uploading and reconciliation with CMS • Imports RAPS, member and provider data from legacy claims systemConfidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 8
  • 9. Voyager Enterprise SoftwareCHART AUDIT TOOL KITThe Chart Audit Toolkit allows plans to manage and monitortheir retrospective and prospective risk adjustment programs. • Project Creation – Users can create custom chart audit projects by adding charts related to members and or providers • Planning and Scheduling – Assign charts to auditors and vendors, schedule and confirm provider appointments • Project Monitoring – Visibility of project status and monitor progress of any program • Record and track results for ROI – Auditor either enters the diagnosis results from their audit using the web interface OR upload excel spreadsheets in to the application allowing for ROI reporting by project and RAPS submission • Generate Auditor Field Packets – At the touch of a button, auditors can quickly and painlessly create and print auditor packets that contain critical information for going in to the field. Packets include, Provider Chart Pull List with Provider Contact Information; Maps displaying the offices for each provider; and detailed problem and suspect list for each member that will be audited.Confidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 9
  • 10. Voyager Enterprise SoftwarePDE MANAGEMENTPDE Management allows a plan to monitor the PDE data submissions from their PBM and track PDEsthat are accepted and rejected and why.Plans are responsible for complete submissions of PDE data reporting with little ability to monitor theresults of their PBM’s data submissions and resubmissions. • Monitor PDE Errors – Report and track PDE errors on PDE transactions by error code and group by type of error • Correct Errors - Create and queue corrective action tasks to resolve PDE errors and ensure acceptance of PDE transactions • Identify Error Causes – Side by Side views of PDE and Drug Claim data allows for quick identification of differences and discrepancies • Work Flow – Use automated and manual work queues to track error resolution for PDE transactions that have been rejected • PDE History – PDE submission and history are created showing what PDE transactions have been created, stored, submitted and deleted.Confidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 10
  • 11. Voyager Enterprise SoftwarePDE AUDITPDE Audit allows a plan to calculate an internal viewof PDE transactions based on actual Drug Claim,formulary, benefit design and membership data.Allows the plan to identify covered drug claims thatshould have been reported and were missed andverify the accuracy of the cost and payment fields. • Monitor PDE Content Errors – Easily identify PDE calculation errors in cost and payment fields • Verify Paid Drug Claims Are Reported – Identify covered drug claims that have not been reported to CMS and should have been reported to be correctly reimbursed by CMS • Identify Mis-Reported Values – Quickly find PDE transactions that have not been retroactively processed for changes in Member Data like retroactive LICS changes • Verify Claims are Adjudicated in the Correct Benefit Phase – Internal view of PDE transactions provide a discrepancy where PDEs have been processed in the wrong benefit phase because of incorrect TROOP or Gross Covered Drug Cost TrackingConfidential, Dynamic Healthcare Systems, IncDYN-XX-201007Page 11