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