PLAN BENEFITS | RECORD RETRIEVAL SOLUTIONS FUNCTIONS |
| INSOURCE | OUTSOURCE | PORTAL REQUEST TECHNOLOGY | AUTOMATED TECHNOLOGY |
| Plan sends remote retrieval requests fulfilled by provider | Plan performs on-site retrieval requests | Plan sends remote retrieval requests fulfilled by provider | Plan performs on-site retrieval requests | Technology vendor sends on-demand requests via portal | CAVO Connect uses FHIR calls to extract records |
| Automate record retrieval process | Record availability timeline | Hours – weeks, dependent on provider staff workload and delivery method | Hours – days, dependent on plan staff workload | Hours – weeks, dependent on provider staff workload and delivery method | Hours – days, dependent on plan/vendor staff workload | Minutes – days, dependent on provider response timeline | Real-time |
| Record capturing process | Manual by provider staff | Manual by plan staff | Manual by provider staff | Manual by plan’s record retrieval vendor staff | Manual by plan or plan’s record retrieval vendor staff | Automated via API, directed by payer-provider contract |
| Record yield | Dependent on provider staff bandwidth | Dependent on plan staff bandwidth | Dependent on provider staff bandwidth | Dependent on plan’s record retrieval vendor staff bandwidth | Dependent on plan’s record retrieval vendor staff bandwidth | Only limited by configurable guardrails agreed upon with provider |
| Increase claim review productivity | Record format and data received by plan for review | PDF image (with/without metadata) | PDF image (with/without metadata) | PDF image (with/without metadata) | PDF image (with/without metadata) | PDF image (with/without metadata) | PDF image (metadata + discrete data) and discrete clinical information (optional) |
| Minimize provider abrasion | Ongoing provider administrative burden | Yes – release of information + potential follow-up and duplication of requests | Minimized – EMR user access, vendor/visitor credentialing, etc. | Yes – release of information + potential follow-up and duplication of requests | Minimized – EMR user access, vendor/visitor credentialing, etc. | Yes | Negated/None |
| Provider revenue risk analysis (optional provider service) | No | No | No | No | No | Yes |
