Praxevo puts the evidence behind every code, so denials, downcodes and underbills drop now. The same evidence from the record and claim history finds the patients a program can help, and builds the way to pay for their care up front.
What a clinician documents, and what a coder builds from it, decide what gets paid. Miss the evidence, compromise the reimbursement.
Automated coding is where it starts. Each code ships with the record quote, the rule behind it, the reason, and what was ruled out. Then the claim is edited before it leaves, so the risks drop.
Suppressed up front now. Replaced by the program next.
A specialty's cost concentrates in a few patients. Praxevo reads claims and records to find them, then runs a program with the payer: managed with evidence, paid up front.
A population has tiers of clinical risk, each carrying greater cost.
Across all patients, the top 5% account for about half of US health spending.
Sources: Sargen, Hoffstad and Margolis, J Diabetes Complications 2013 (Medicare, 2007). Honeycutt et al., J Am Soc Nephrol 2013 (Medicare, 2010 dollars). USRDS Annual Data Report 2018 (dialysis, 2016). AIR brief on crash dialysis starts. AJMC, dialysis costs for one health system in value-based care (Cleveland Clinic). Hurst et al., N Engl J Med 2010 (COPD flare-ups by GOLD stage). ISPOR 2020 abstract (COPD cost, Medicare 5% sample, 2014). Olmsted County Heart Function Study (heart failure stage A to B to C). Milliman, Heart failure cost in Medicare, 2015. Clinical reviews of ulcer-to-amputation risk (80 to 85%). AHRQ MEPS Statistical Briefs.
Migrate risk bearing patients to a partner program to change the trajectory of care delivery cost and quality.
Wellness visits and situational needs. They stay on fee-for-service, with better dollars today.
Managed in a program with a partner. Paid up front, with the evidence to prove the results.
Claims and Record Analytics automate identification of Program Tier Populations
Each ring opens when the outcomes of the one before it show results.
Nothing switches over all at once. Quality and savings are measured, and the proof lets the program expand.
Every patient. Claims still pay, with the coding evidence attached and the risks edited out before submission.
Patients with emergent risk move into a program and are paid up front. Everyone else stays on fee-for-service.
Every patient is paid up front, and the legacy conflicts and overhead of claims-based payment fall away.
Care Payments are unlocked by Evidence.
The same chain runs from the first coded encounter to the last Care Payment.
The engine that executes healthcare's precision workflows, reading the record, applying the rules and showing the evidence behind every decision.
Coders change from author to auditor enhancing quality and throughput for cleaner claims.
New transactions beyond EDI, packaged with evidence so partners share visibility and clarity.
New Clearinghouse where provider and payer meet for greater collaboration.
See the criteria, rule and record criteria that govern and evidence the AI determinations.
Learn how claims and records auto-build proposed program populations.
View the trust transactions that drive care delivery cost and quality improvement.
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