ACO and Collaborative
Building excellent ACO services requires a deep understanding of claims processing and the algorithms that drive those processes.
we have the unique expertise in aco data flow
designing and building effective connections between ACOs, Medicare and other payers
Simply put, we bring efficiency in systems integration, meaning less waste and real savings for your organization. If you’re just starting out, we can partner with you to design your system and set up your ACO. If you’re already up and running, we’ll take a macro view of your data management architecture and help find efficiencies or enhancements. No matter the stage of deployment you’re in, we can help.
Advocate Physician Partners (APP)
In partnership with the Center for Medicare and Medicaid Services (CMS) Advocate saved Medicare taxpayers and beneficiaries more than $61 million in 2018. Ranking second in savings of 432 ACOs participating in the Medicare Shared Savings Program (MSSP). Advocate was among the highest in quality results while providing care to the largest group of Medicare beneficiaries.
“Byte Sized Solutions has the depth and knowledge to handle diverse data sources, file types, and integration types. This allows them to develop efficient tools to drive new processes and payer mandates.”
— Terri Godar
Director of Information Services, Advocate Health Partners
what we do
ACO/Healthcare Business Expertise
- Medical and pharmacy claims metrics, reporting and analysis (e.g. ODAG and Part C reporting to CMS)
- Member eligibility metrics, reporting and analysis
- Member/PCP attribution using Medical Claims History and Geospatial Mapping
- Distribution and management of claims to staff for processing
- Member Out Of Pocket (MOOP) Processing and Reporting
- Provider management and reporting
- Internal controls and error checking for claims processing
- EDI files/EDI generator, an application to digest 837 and 834 field and to parse files and load them into SQL warehouse
- Clinical and Business Process Automation
- File web download and parsing (e.g. from payers)
- File preparation and web submission (e.g. to payers)
- Letter generation and printing