ClaimSphere™ HEDIS® system is designed for the IT and business user and helps health insurance payers gain a deeper understanding of their population, deliver better care and reduce costs. Available on-demand and in the cloud, ClaimSphere™ HEDIS® identifies key issues in patient data that impact scores and helps the payers take corrective action to improve the HEDIS® quality rating.
ClaimSphere™ Self-service Business Intelligence tools uncover the root cause of low HEDIS® scores. This unprecedented information transparency gives the payers insight into the underlying cause of HEDIS® score changes and helps the payers to analyze poorly-performing measures to take appropriate action. Care gap and performance reports from ClaimSphere™ HEDIS® summarize quality of care delivered by providers and highlight any care disparities. Multiple canned reports and Ad-hoc analytics is available for follow-up action planning.
Data integration and administration tool manages admin and supplemental data sources intake, cross walks for custom codes to standards and schedule and monitor jobs to seamlessly manage HEDIS® workflow till the lock down and IDSS & PLD submission. The tool improves efficiency of IT staff and maintains audit trail for supplemental sources required during the HEDIS® compliance Audit.
Create variations of "gold standard" measures by modifying granular rules using a Measure Editor and Builder tool. Construct measures with complex parameters, population, denominator, numerator and exclusions. Sentinel medical events are created and maintained in a code configuration library that captures the complexity and richness of any evidence based measure.
Onsite and Remote chart abstraction services for Hybrid measures enabled through Cognizant's RNs working out of a URAC accredited facility.
ClaimSphere™ HEDIS® is Cognizant's NCQA-certified HEDIS® solution for healthcare payers. It is a robust yet simple-to-use product to analyze, monitor, intervene and improve quality of care and meet yearly state and national regulatory requirements with the flexibility to meet health plan specific quality improvement objectives.