NaviMedix builds platform to connect payers and providers

CAMBRIDGE, MA – A handful of revenue cycle management vendors are coming together to help hospitals better manage payment responsibilities at the point of care.

The initiative is spearheaded by NaviMedix, a Cambridge, Mass.-based provider of communications software and services connecting healthcare providers and payers. With plans to create an “all payer, all patient” payment system, the company acquired Topline Solutions, Inc., which provides healthcare payment and collection solutions, and is partnering with ClearCycle, Ingenix and Moneris to set up its revenue cycle management platform.

The key to that platform, says Tom Morrison, vice president of marketing and product development at NaviMedix, is a system that allows health plans to take part no matter how far along they are on the IT curve.

“Different plans are at different levels of providing payment estimates,” he says. “Those payers need to evolve along their own lines and still be supported.”

The evolution of consumer-directed health plans (CDHPs) has given patients more responsibility for paying healthcare costs – and forced providers to figure those payments more prominently in revenues. Morrison says the new RCM network will enable providers to figure out up front how much of the cost of services is the responsibility of the patient, then reconcile patient and payer payments through the company’s NaviNet platform.

“This … is a critical piece of the equation to enable real-time adjudication in today’s complex healthcare payment infrastructure,” said Tim Hargarten, NaviMedix’s CEO. “It will accurately estimate patient financial responsibility and will easily reconcile payments from all sources.”

The company’s new platform, according to NaviMedix officials, will enable providers to determine, capture, process and reconcile patient responsibility for service; support reconciliation of all payments through a health plan’s transaction system; and allow for real-time claims adjudication.

“As an industry, we’ve always jumped to the end-stage – without looking at the process in between,” said Morrison. “This enables everyone to get sort of reduced to the lowest common denominator of capability.”