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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.
"HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)."