Solutions

ProviderBASE℠ is a platform service that was built to bring the entire process of medical ordering, authorization, referrals, coordination, rendering and reporting into one unified, real time, online resource hub.

Anyone who has experienced the myriad different burdensome workflows and exchange involved with processing orders and getting patient services provided in conjunction with payer rules, prior authorization and referral agents, understands immediately the unnecessary complication and opportunity for improvement that is prevalent at every point.

ProviderBASE is the essential solution needed to manage the entire medical ordering and fulfillment process through a flexible and easy to use, cloud-based application. ProviderBASE helps ensure the right order, at the right time, in the right place and at the right price.

 


The Challenge

Most patients with health or insurance coverage needing clinical testing, treatment or supply services, and nearly anyone working in the healthcare or insurance industry, will attest to how difficult and cumbersome the medical ordering process has become. Yet ordering accuracy, efficiency and effectiveness are key to cost containment and patient outcomes.

Today, layer upon layer is stacked with fragmented, inconsistent and onerous processes for order entry, submission, review and verification, patient benefit and service pre-approvals, authorizations, referrals, reports and billing. Multi party hand-offs and mostly disconnected coordination between providers, payers, patients and agents is the norm, along with an immense amount of paperwork and phone calls.

This wasteful reality requires an incredible amount of extra time, effort, distraction and expense to confirm and coordinate between every stakeholder, adding delays and driving up the costs of insurance claims and healthcare delivery across the board.

Our Answer

Imagine if the entire medical ordering-to-service provision process — from patient encounter through order verification, authorized referral delivery through service coordination, and reporting to final payment — was handled via a single, unified platform that allowed every party involved to access information without additional follow up. Service authorization, pricing, referral coordination and billing would become faster, easier, more accurate and transparent.

Physicians, office staff and patients could instantaneously and completely self-process ‘appropriate’ and pre-authorized orders, with referrals to optimal networks, vendors, suppliers and providers. This would allow for accelerated scheduling, service dates, follow up treatment and appointments, and the capturing of discounted refer-to provider rates, all processed and confirmed at the time- and point-of-order.

Nurses, care managers and administrators could review physician orders and CDS scoring levels against payer authorization requirements, auto-process approvals, and direct referrals to designated provider networks – or have patients self-schedule at their convenience – with everyone ‘on the same page’ and without submitting calls, faxes, mail or other paper.

Ultimately, medical ordering and patient services would be more ‘appropriate’, unnecessary utilization would decrease, and the entire process would become streamlined and reduce costs at every step.

 

“Everyone except those that have made a racket off excessive treatment, unnecessary utilization review, inflated medical device sales, or permanent disability settlements will benefit.”  – Leading Workers Compensation Guideline Publisher


The Difference that the ProviderBASE Platform Offers

Before ProviderBASE

After ProviderBASE

With a medical management or healthcare model that utilizes the power of the ProviderBASE Platform, we begin to see an entirely new workflow emerge that values higher levels of quality, accessibility, savings and returns within a shorter time table.

With ProviderBASE there is seamless direction of authorized orders and referrals to designated networks, suppliers and contracted providers delivering services at discount rates and which also meet clinical and patient requirements — taking the confusion, error, delay and manual costs out of the process.

The added filtering of orders and referrals based on transparent pricing and costs, ‘appropriateness’ guidelines, payer rules and network providers will promote better physician and consumer choice along with elevated cost containment program savings and net returns.