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Johns Hopkins Well being Plans is wading additional into the bogus intelligence waters with a partnership meant to make sure member compliance with the No Surprises Act.
How about – prompt lede – Johns Hopkins Well being Plans is initiating a synthetic intelligence partnership meant to make sure member compliance with the No Surprises Act.
By adopting InsightPro from MDI NetworX, Johns Hopkins Well being Plans (JHHP) is addressing what it sees as a problem surrounding the No Surprises Act: Whereas the regulation created transparency for sufferers and safety in opposition to sudden billing, it additionally introduced new compliance necessities that left many well being plans “scrambling,” in line with Johns Hopkins.
Ryan O’Donnell, chief working officer for Johns Hopkins Well being Plans, known as the know-how “revolutionary” and stated it will guarantee members have correct, up-to-date supplier data, and would promote belief within the firm’s companies.
WHAT’S THE IMPACT
Powered by AI, the analytics platform has already yielded important advantages for Johns Hopkins Well being Plans, the corporate stated.
For one, it has ensured well timed updates to supplier directories, leading to improved transparency for sufferers and minimizing billing confusion, in line with JHHP. It has additionally offered progress monitoring and high quality assurance capabilities to restrict errors in listing listings.
The group added that the know-how has decreased claims displaying incorrect member cost-shares, thereby selling a smoother member expertise and lowering member and supplier abrasion.
“As a managed care group administering authorities applications, compliance with legal guidelines and laws is essential,” stated John Wells, government director of compliance for Johns Hopkins Well being Plans. “Know-how that reduces errors and improves high quality assurance makes us stronger for these we serve.”
JHHP started inching into the AI payer house earlier this 12 months when it launched a brand new multi-payer portal to attach suppliers and payers. Utilizing the real-time, AI-driven platform, supplier places of work will have the ability to submit and monitor digital claims, claims standing, remittance and claims cost data, in line with Johns Hopkins. It helps suppliers with insurance coverage claims and prior authorization requests.
An AHIP survey launched earlier this 12 months confirmed that through the first 9 months of 2023, the No Surprises Act protected Individuals from greater than 10 million shock medical payments.
THE LARGER TREND
Johns Hopkins Well being Plans administers provider-sponsored well being plans backed by the medical analysis of Johns Hopkins Medication.
As a joint entity of the Johns Hopkins Well being System and the Johns Hopkins College Faculty of Medication, Johns Hopkins Well being Plans serves almost 450,000 members in Maryland and the Mid-Atlantic area.
Johns Hopkins Well being Plans has 4 well being plans: the US Household Well being Plan, Employer Well being Packages, Precedence Companions and Benefit MD. It manages greater than $3 billion in annual premiums.
It additionally has a Options and Improvements enterprise in partnership with Johns Hopkins college and suppliers, turning analysis and concepts into digital merchandise, together with the inhabitants well being analytics software program known as the Johns Hopkins ACG System.
Johns Hopkins Medication, primarily based in Baltimore, has six tutorial and neighborhood hospitals, 4 suburban well being care and surgical procedure facilities, over 40 affected person care areas, a house care group and a world division.
Jeff Lagasse is editor of Healthcare Finance Information.
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Healthcare Finance Information is a HIMSS Media publication.