Zane Networks, LLC Launches Offering to Improve Payment Integrity in Healthcare
Approach enhances coordination of benefits for Medicaid and managed care plans while reducing overpayments and recovery costs
WASHINGTON, D.C. – March 21, 2022 – Zane Networks, LLC, a leader in healthcare transformation services and solutions is launching a service offering to improve payment integrity and streamline the coordination of benefits (COB) processes for Medicaid and managed care plans.
Zane Networks developed the workflow framework and data quality standards necessary to integrate CAQH’s coordination of benefits product, COB Smart® for its customers. This allows for the identification of primary and secondary healthcare coverage before claims are paid – increasing payment accuracy while reducing the administrative costs associated with recovery. By collating, reconciling and analyzing data from CAQH and other sources, Zane Networks will help state agencies and health plan clients interpret coverage determinations to facilitate member research, enable plan-to-plan inquires, and track claims for faster coordination of benefits resolution.
“Payment integrity has become a multibillion-dollar problem for the U.S. healthcare system with improper payments nearly tripling over the past decade,” said Alexandra Jellerette, president of Zane Networks. “By providing crucial oversight that both confirms data quality and secures the privacy of that data, we are able to improve payment accuracy for our clients while reducing expenditures associated with member canvassing, claim reprocessing, data validation and recovery.”
“Medicaid plans must constantly maximize limited resources and meet their obligation to be the payer of last resort,” said Morgan Tackett, vice president of product management at CAQH. “With a database of more than 200 million covered lives from every large national health plan in the US, COB Smart is the most effective way for programs to meet these challenges, while ensuring that claims are paid accurately the first time.”
CAQH’s COB Smart provides weekly validated medical data overlaps at a 99.5% accuracy rate to ensure claims payment accuracy and to avoid the administrative costs involved with the resubmission of claims. The product improves the member experience by reducing the number of pends, denials, touch points, phone calls and letters – effectively taking them out of the coordination of benefits process. It also improves provider and member satisfaction by expediting eligibility and automating claims processes.
In late 2021, Zane Networks significantly enhanced the Coordination of Benefits program for a regional Medicaid agency – helping them to improve processes for their beneficiaries with overlapping coverage, while ensuring that all claims are paid correctly the first time.
About Zane Networks, LLC
Zane Networks was founded in 2000 by Alexandra Jellerette, MA, and Luigi Leblanc, MPH as an Economically Disadvantaged Woman-Owned Small Business (EDWOSB) and Minority Business Enterprise (MBE). With over 20 years of unparalleled service and performance, Zane Networks has established partnerships with more than
24 government entities and provided unique services for over 500 healthcare practices, hospitals, and clinics. With direct technical support, coaching, and software development and implementation, Zane Networks equips customers with innovative health IT tools and health data. To learn more about Zane Networks, visit www.zanenetworks.com.
For more than 20 years, CAQH has helped nearly 1,000 health plans, 1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently. CAQH technology-enabled solutions and its Committee on Operating Rules for Information Exchange (CORE) bring the healthcare industry together to make sharing business information more automated, predictable and consistent. CAQH Explorations researches opportunities to reduce the burden of manual processes in healthcare administration. Visit www.caqh.org and follow us on Twitter: @caqh.