PLAN BENEFITS
|
RECORD RETRIEVAL 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 |
