BioIQ now has the ability to submit claims for its products and services delivered on behalf of commercial and Medicare Advantage plans, as well as on behalf of employer clients. This seamless process helps health plans meet the minimum medical loss ratio (MLR) threshold while simplifying claims billing for employers that provide health screening services to their employees.
For Health Plans
BioIQ can bill its program components as a claim, including at-home test kits, member engagement offerings, test-kit sample processing (through labs in BioIQ’s network) and kit administration.
The benefits of billing for BioIQ’s products and services as a claim are significant because the cost of running a program is attributable to a health plan’s medical loss ratio (MLR), the financial target that insurers are required to meet. Both small group and large group health plans must report their MLR, which represents how much of their premium is spent on claims and expenses that improve healthcare quality and how much is being spent on administration, fees and profits. In cases where the minimum MLR percentage is not met, plans must issue rebates to the policyholders.The flexibility of submitting claims enables employers and health plans to manage MLR and administrative costs proactively instead of being confined to invoicing, which is directly attributable to administrative expense only.
BioIQ’s services can now be billed as medical costs (overall plan medical expenses) versus administrative costs (quality improvement’s defined budget), thus not limiting the plan’s budget and providing greater fiscal flexibility. For Medicare Advantage plans, which are required to spend at least 85 percent of their revenue on healthcare services, covered benefits and quality improvement efforts, this simple change in billing makes finding the budget to run a gap closure program much more realistic. On the commercial side, the advantage is that employers can pay for services rendered to program participants with administrative ease via claim submission directly through their health plan.
To ease the administrative burden of recognizing gap closure or HEDIS events in Medicare Advantage populations, BioIQ utilizes CPT II codes for submission of FIT, A1C, Microalbumin and Diabetic Retinal Eye (DRE) exams.
BioIQ streamlines medical claims billing for employers hosting screening events and for health plans receiving these claims. An electronic claim (ANSI 837) is submitted for each participant through Availity, BioIQ’s preferred EDI clearinghouse for claims processing.
This enables fully insured employers to bill wellness services as a claim against their health plan, as opposed to paying for the services directly. Self-insured employers also receive the same benefits as those that are fully insured, although the employer does have to agree to cover costs that the health plan may not pay.
To learn how your organization can simplify claims-based billing, contact BioIQ at (888) 818-1594 or firstname.lastname@example.org.