OREANDA-NEWS. July 05, 2013. McKesson has debuted the latest version of its claims payment optimization technology, the McKesson Total Payment™ platform, as part of its ongoing commitment to helping payers and providers navigate the complexities of healthcare reform. Enhancements in version 5.1 help payers more easily collaborate with providers in the transition to value-based reimbursement strategies, such as bundled payments for episodes of care. The latest version also extends a payer's ability to identify and prevent waste, abuse and fraud.

"Payers are looking for flexible solutions that allow them to test and scale new reimbursement methods consistent with healthcare reform initiatives. At the same time, they understand that fee-for-service payment will continue to be part of the reimbursement equation for the foreseeable future," said Mike Flanagan, associate vice president, Product Management, McKesson Health Solutions. "Through some key integrations with synergistic products in our portfolio, McKesson Total Payment can help health plans efficiently and accurately automate combinations of reimbursement methods, no matter how multifaceted and complex their policies and contractual arrangements might be. Doing so will help improve provider satisfaction and lower medical and administrative costs."

The McKesson Total Payment platform provides the technical foundation for two of the company's Financial Management solutions: ClaimsXten™, which provides clinically based claims auditing for payment accuracy, and McKesson Episode Management™, which supports full-scaled bundled payment programs. New integrations help ClaimsXten and McKesson Episode Management combine to enhance the capabilities of core claims processing systems, enabling them to automate payment to providers for different risk-sharing arrangements and complex benefit designs.

The McKesson Total Payment platform's advanced technology framework and intelligent rules engine can process both fee-for-service and bundled payment claims simultaneously - including correct pricing via McKesson Reimbursement Manager™. Edited claims can then pass through McKesson's predictive analytics engine in InvestiClaim®, an enterprise-level waste, abuse and fraud management system, to identify aberrant billing activity. The result is more accurate and automated claims payment, no matter how complex the payment and medical policies and provider contract terms.

Key enhancements in the new version include the following:

Bundled payment program. McKesson Episode Management capabilities have been expanded to fully support an automated approach to bundled payment programs. This release helps automate claim operations by identifying, reconciling and paying claims that are part of a bundled payment arrangement. In addition, interactive dashboards allow plans to manage an overall bundled payment program and share actionable information with providers participating in the program.

Improved payment integrity. As payment complexity increases and the industry transitions to ICD-10, payers are not only challenged to pay claims correctly but also to detect waste, abuse and fraud. This is adding administrative stress to already overburdened organizations, and potentially exacerbating adversarial relations between payers and providers. Integration of the McKesson Total Payment platform with InvestiClaim can help users address this intensifying challenge. InvestiClaim partners pre-pay clinical editing rules and pre- and post-pay predictive analytics to help avoid a higher volume of wasteful and abusive claims up front and make fraud recovery efforts more efficient on the back end.