Episode Manager

A value based payment solution for payers that want to integrate prospective payment models into their existing claims workflows.


ScaleYour Prospective Bundled Payment Program

  • Streamline program administration by identifying episodes from a trigger claim within your existing claims system workflow and bundle all episode claims in near real-time.

  • Configure your own episode definitions or leverage Prometheus or CMS episode definitions.
  • Integrate fee-for-service pricing by using both Episode Manager and ClaimsXten on the same technical platform, allowing for an efficient mixed model payment approach.

  • Develop and manage bundled payment programs that help define your episodes or reevaluate your existing strategy.

Streamline Prospective Payment Processes

  • Automate prospective bundled payment processes

    • Configure our rules-based solution that works within your current claim workflow to bring automation to prospective bundled payment programs.
    • Combine clinical dashboards and claims transaction functions to help support prospective payment programs at scale, promote quality care, and help reduce administrative and medical costs.
    • Simplify the transition from retrospective to prospective payment models approach when you are ready.
  • Configurable episode of care definitions

    • Support for multiple episode configurations and custom episode definitions.
    • Leverage Prometheus or CMS episode definitions or customize these definitions to meet your specific market needs.
  • Episode based payments monitoring

    • Allow episode analysts to compare program definitions to actual claim data and to recognize trends with summary and detail reports.
    • Get a clear and consistent view of key performance metrics associated with episodes from visual dashboards.
    • Help Adjudicate claims quickly and accurately to all the providers included in the episode of care.

Our outcomes

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