PRIMEridian is available to enhance customer's internal operations through an application service provider (ASP) model as well as through Meridian's business process outsourcing (BPO) services. The system completely integrates provider credentialing, eligibility and benefits, utilisation management and claims processing functions, allowing clients to leverage automation and Web-enabled processes to reduce costly, labour-intensive administrative functions that have long plagued the industry.
Health care costs are rising at an alarming rate, and administrative expenses are a major part of this increase. Currently, administrative overhead represents 20 to 30 percent of health care spending, or up to $420 billion each year, with medical claims paperwork accounting for $250 billion.
"PRIMEridian 6.0 offers a highly automated and flexible Web-based claims processing platform that will provide superior speed, accuracy, and efficiency. It will not only save health plans and risk-based provider organisations significant time, money and resources in their administrative functions, but it also enables them to comply with HIPAA mandates", stated Michael Hancsarik, vice president of information technology at Meridian Health Care Management.
The new version also allows Meridian clients to more easily institute operational changes needed for consumer-driven health care initiatives. Using the Versata development environment, PRIMEridian 6.0 is a platform-independent, Java-based system that is rapidly modifiable. As a result, version 6.0 will allow new pricing schemes and member benefit scenarios to quickly and accurately be incorporated, without the additional time and resources once required by extensive programming modifications.
"PRIMEridian version 6.0 is a state-of-the-art claims processing system", stated Michael Hancsarik. "We currently achieve a claims accuracy rate of 99 percent, and an average of seven days receipt on hand. Meridian currently achieves auto-adjudication rates between 45 and 65 percent depending on individual client network, contracts and benefit configurations. With version 6.0's significantly enhanced contract, benefit, and other business logic adjudication capabilities, we expect to achieve auto-adjudication rates of more than 80 percent in virtually all client environments."
"As part of Meridian's long-term, strategic plan to deliver exceptional customer service, administrative services and leading-edge technology solutions to the health care market, these latest innovations are crucial to our commitment to efficiency and cost-effectiveness in managed care", stated Michael Alper, president of Meridian Health Care Management.
Meridian offers a full spectrum of outsourcing services and management to provider organisations, health plans and hospitals, which include a complete turnkey management solution, outsourced administrative services, access to integrated information technology and consulting services.