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McKesson Health Solutions unveils ClaimsXten Policy Management


NEWTON, Mass. — McKesson Health Solutions on Monday announced its new clinical and payment management solution, ClaimsXten Policy Management, which it says can help cut costs and improve “first pass” payment accuracy by streamlining and automating advanced policy rules and clinically sourced edits. 


ClaimsXten’s Policy Management Module us a single-rule framework that users can then layer into multiple policies, providing an enterprise foundation for streamlining the creation, deployment and maintenance of a variety of policies and edits. Payers can use PMM to address edits early on in the adjudication cycle, and they can enable advanced policy designs, including compliance and payment policies, as well as special investigation requirements, among others. 


“Payers are struggling to manage the pace and breadth of industry change because their disconnected legacy systems aren’t up to the task,” McKesson Health Solutions VP clinical claims management Amy Larsson said. “Payers need to ensure accurate payment for a wide variety of relationships with their provider networks, and they want to pay providers quickly according to their policy. With ClaimsXten’s PMM, we’re making it easier for health plans to compete with speed and agility in a market that’s becoming more complex and competitive every day.”


McKesson Health Solutions said that PMM works to make it easy for payers to facilitate the move toward value-based reimbursement (which payers expect 60% of providers to be in five years from now), making it possible to implement policy changes in a matter of weeks. The company also said the PMM helps promote fast, accurate payment on the first pass, reducing the potential of retrospective recovery and third-party audits and appeals. 


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