ClaimsDX Outpatient

The Skein Health ClaimsDx Outpatient Product is a full suite of modules designed to allow you to view a variety of outpatient claims data.  The product puts the power of insight into the hands of business owners to quickly evaluate status, identify opportunities, prioritize action, and monitor results across a spectrum of service areas.  

Using the same intuitive “drill-down” interface as ClaimsDx Inpatient and ClaimsDx Post-Acute, ClaimsDx Outpatient delivers powerful analytics into Medical Benefit Pharmacy, Home Health, DME, Prosthetics, Orthotics, Simple, Complex, and Therapeutic Radiology.  

Radiology Module

Radiology is a diverse group of services.  Simple Radiology is mostly X-rays and is largely managed with contracting.  Complex Radiology has many service types with corresponding opportunities to manage cost.  Therapeutic Radiology involves complex treatment methods for mostly cancer diagnoses.  You need a way to keep it all straight.  Are you confident you have what you need?  If not, look no further than the ClaimsDx Radiology module.

• Intended for use by prior authorization leaders, finance, network operations, Medical Directors

• For your custom cohort, can lead to answers to these types of questions:

  • Is our network strategy for radiology still working? What are the trouble spots?

  • Our spend for MRI pmpm is high. Is it driven by certain groups? Bad contracts? Particular clinical situations?

  • What is driving our Therapeutic Radiology trend? Is our vendor catching everything?

Procedures and Tests module

Much of the care delivered is done outside the hospital setting.  Utilization rates and unit costs can vary widely.  Having a view into how these service are being delivered across your membership is invaluable and can make a big difference in network, contracting, and UM decisions.  If this is an area that is an opportunity for your organization, the ClaimsDx Procedures & Tests module may be exactly what you need.

• Intended for use by prior authorization leaders, finance, network operations, Medical Directors

• For your custom cohort, can lead to answers to these types of questions:

  • Are episode costs for our top outpatient procedures consistent? Are there outliers that would affect our network strategy?

  • Our spend for the pulmonary category is high. Is it driven by certain groups? Overutilization of particular tests? Bad contracts?

medical pharmacy module

Medical Benefit Pharmacy, aka Specialty Drugs, is consistently a driver of rising costs for almost every health plan in the country.  There is a constant flow of new drugs, new indications... all with difficult to remember and pronounce names.  Keeping up is difficult.  Managing it is even tougher.  If only there were a tool that would let you keep this very important service line in the spotlight that gave you all the information you need to take the right actions.  Enter the ClaimsDx Medical Rx module. 

• Intended for use by pharmacy leaders, finance, Medical Directors, Prior Authorization leaders

• For your custom cohort, can lead to answers to these types of questions:

  • Which providers are over-utilizing the latest monoclonal antibody?

  • Do we have opportunities for improving our unit cost for a key specialty drug?

DME module

Durable Medical Equipment, Prosthetics, and Orthotics represent a dizzying array of items from the simple and very affordable to advanced and high dollar.  Many items are not managed at all.  Some items require prior authorization to determine medical necessity. 

Keeping track of performance is a challenge.  It is one thing to identify a trend in DME spend.  It is quite another to know if it is in the managed or unmanaged cohort, where the variance is coming from and why.  The ClaimsDx DME module will let you see what is driving results and where you need to focus your attention and activity. 

• Intended for use by prior authorization leaders, finance, network operations, Medical Directors

• For your custom cohort, can lead to answers to these types of questions:

  • Are there items not on our prior authorization list that are driving trend?

  • Are we getting consistent unit cost for our high dollar items?

You need an end-to-end view into post-acute claims, with data presented in a way that makes sense along benchmarking designed specifically to help you answer these and many other questions.  You need Skein Health ClaimsDx Post-Acute.  It delivers real value, not just charts, out of the box. Contact us to learn more about how we can help, or to arrange a demo.