New VisiQuate Experience Report Integration Solution Gives Illinois Healthcare Providers True Picture of Their Cash From BCBS of Illinois

VisiQuate, Inc., a leading provider of advanced analytics, intelligent workflow and AI-powered automation offerings to America’s most respected healthcare organizations, announced that its Blue Cross and Blue Shield of Illinois (BCBSIL) Experience Report integration is delivering significant benefits to Illinois healthcare providers.

With its new solution, VisiQuate has created processes that integrate the true data from the Experience Report into its solution and show proper contractual adjustments and net payments at the encounter level. VisiQuate uses this information to create reverse payment transactions and corrected net payment transactions, in addition to computing the contractual adjustments. This gives revenue cycle staff insight into key measures of performance for their BCBSIL book of business and gives them more accurate Accounts Receivable (A/R) numbers.

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It’s vital for hospitals to accurately track and predict actual reimbursements. Historically, BCBSIL has used a Uniform Payment Plan (UPP) program to reimburse contracted hospital facilities for inpatient and outpatient services. Every month, BCBSIL reviews the actual experience of its members at the hospital and adjusts the payment for the following month, information that is shared with the hospital through a monthly Experience Report.

The Experience Report is the only place the hospital sees the true contractual adjustment and final payment for every encounter. But the Experience Report is a lagging indicator, not a real-time snapshot. Obviously, this can give providers a dangerously distorted view of their current cash situation.

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Before this new solution, for example, one client’s cash would have been listed at $284 million, which is significantly overstated. But when the VisiQuate solution precisely integrated BCBSIL UPP data, the correct posted cash was shown to be $189 million. Thus, the VisiQuate solution prevented the Experience Report from overstating this client’s cash by $95 million!

“Fortunately, that problem is now in our clients’ rear-view mirror,” Stephen Delaney, VisiQuate SVP Client Development, said.  “Our clients just upload the monthly reports to VisiQuate and we do the rest.”

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