LYNNFIELD, MA – July 22, 2019
Advanced Medical Strategies (AMS), the leader in strategic intelligence software for clarity into complex claims, is pleased to announce the launch of Predict Profiler. This reporting and analysis software module identifies high dollar diseases and high-risk individuals at-a-glance in a user-friendly web-based system.
Predict Profiler differs from population health reporting; it organizes, analyzes, predicts and benchmarks claimants from both diagnosis and drug perspectives. With Predict Profiler, stakeholders in the self-funded space can see for the first time not just who is at risk, but pinpoints what exactly is driving the risks and costs in their groups of business. It delivers vital risk feedback and trigger reports which allow for the quick and simple identification of previously hidden claims that were buried underneath layers of file formats and code.
“AMS is thrilled to present Predict Profiler to our Predict Suite members,” says Peter Borans, AMS President. “Predict Profilerstreamlines what was once a difficult and labor-intensive process (i.e., disclosures, trigger reporting, high cost claimant reviews) into a clear, concise and exceptionally robust system specifically developed from our decades of experience. In minutes, AMS clients have a multi-dimensional view of claims thanks to the custom mapping feature which facilitates a one-and-done, simple uploading of files. They can also export reports for further analysis since all the mapping and organization is built in. These two vital components which expedite inflow and output from Profiler have been sorely lacking in the self-funded market — just a couple of reasons why Predict Profiler was, by far, the runaway hit of this year’s Member Forum at our annual Symposium.”
Predict Profiler allows for completely unobstructed views of trigger diagnosis/ICD10 codes, Specialty Rx J codes,members/claimants, groups, and provider data with costs, deductibles, billed, allowed, and paid amounts, and variable percentage reports. Profiler provides actionable insights for all those along the healthcare payer chain. Specific industry solutions:
Stop Loss, Reinsurance and MGUs
• Simplifies the claims disclosure process
• Identifies the most high-risk claimants by Diagnosis, Drug, and Members
o Includes predictive analytics based on billions ofdollars of like claims
o Benchmark diagnosis and drug costs by unit and yearly costs
• Streamlines the process for reporting on disparate data in the format you need most
• Maps all ICD, CPT and J codes to their descriptions
• Highlights multiple diagnoses within a specific claimant
TPAs and Brokers (all the above, plus)
• Eliminates the complex process of trigger reporting to Stop Loss and Reinsurance partners• Detects high dollar transactions not otherwise related to a typically costly diagnosis
• Analyzes cost drivers within a group or across a block
The solutions listed above drastically reduce the complexitiescommonly associated with communication and disclosure between Administrators and Carriers. In short, clients can improve production time by 50% with Predict Profiler.
AMS is available to showcase the Predict Profiler via demos today. To learn more about AMS and see Predict Profiler in action, contact Stephanie Belschner at 781.224.9711 Ext. 116 or firstname.lastname@example.org.
Advanced Medical Strategies (AMS) is the leader in strategic intelligence software for clarity into complex claims. We solve affordability of care issues with a targeted focus on Specialty Pharmaceuticals, Catastrophic Diagnoses and Medical Implants. AMS’ Predict Suite combines technology, clinical expertise, financial insight and data science into an easy to deploy, subscription-based service that brings strategic intelligence and risk mitigation to high cost claims issues.