© 2021, nThrive Revenue Systems, LLC. All rights reserved. RO821

2021 VIRTUAL USER FORUMS

PRODUCT STRATEGY AND ROADMAP OVERVIEW

Claims Management

Taylor BynumDirector of Product Management

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2022 Roadmap and Cross Product Integrations

Roadmap items on the Radar

Poll – Medicare DDE Emulator

Poll – Word Cloud – Missing Features

Poll – Availability/Uptime expectation

Brief comments on transition to the web

Open Q&A

Claims Web Application Claim Attachments

WHAT

• Attach and submit electronic Medical Records via Jopari• Confirmation of attachment submission• Import reconciliation of attachments to Claim• Edits to drive attachment management for supported payers• Manually Attaching Medical records

WHY

• Market demand for electronic medical records• Decrease cost to collect for clients• Increase overall claims value proposition• Buys time to set up clearinghouse connectivity for attachments by

using a trusted partner Q1

Automated

Attach and

submit

medical

records

Review

supporting

payers

Q4

Q3

Q2

Manual

Attach of

Medical

Records

Improve Client Efficiency and Experience

Review

Supporting

payers

TIMELINE

Amerigroup

ANTHEM BC CA

ANTHEM BCBS CO

ANTHEM BCBS CT

ANTHEM BCBS MO

ANTHEM BCBS NV

ANTHEM BCBS OHIO

ANTHEM BCBS VIRGINIA

Anthem Blue Cross Blue Shield Georgia

Anthem Blue Cross Blue Shield Indiana

Anthem Blue Cross Blue Shield Kentucky

Anthem Blue Cross Blue Shield Maine

Anthem Blue Cross Blue Shield Nevada (Medicaid)

Anthem Blue Cross Blue Shield New Hampshire

Electronic Attachment Payer Connections

Anthem Blue Cross Blue Shield Wisconsin

Anthem Maine Health

BCBS Western NY (Medicaid ONLY)

BCBSMN BLUE PLUS MEDICAID

CLEAR HEALTH ALLIANCE

COLORADO COMMUNITY HEALTH ALLIANCE

DELL CHILDRENS HEALTH PLAN

EMPIRE NY

Healthy Blue Dual Advantage

Healthy Blue Louisiana

Healthy Blue South Carolina Medicaid

Healthy Blue South Carolina

NC Healthy Blue

SIMPLY HEALTHCARE

BCBS of AL

EMI

National Government Services (NGS) - J6 IL Part A and B

National Government Services (NGS) - J6 MN Part A and B

National Government Services (NGS) - J6 WI Part A HHH (AK, AZ, HI, ID, MI, MN, NV, NJ, NY, OR, WI, WA) and Part B

National Government Services (NGS) - JK CT Part A - Empire BCBS Ny and Part B

National Government Services (NGS) - JK MA Part A and B

National Government Services (NGS) - JK ME Part A HHH (CT, ME, MA, NH, RI, VT) and Part B

National Government Services (NGS) - JK NH Part B

National Government Services (NGS) - JK NH, VT Part A

National Government Services (NGS) - JK NY – 2 and 3 Part A and Part B

National Government Services (NGS) - JK RI Part A and B

National Government Services (NGS) - JK VT Part B

New Payer connections will be continually evaluated, edits will be updated accordingly

All Jopari Worker’s comp attachments will be included in offering

Claims Web Application Follow Up, Remittance Management, Manager

WHAT

• Follow Up - Deliver find and search EOBs from web application UI• Cash Posting - Deliver find and search Remittance files in web

application• Begin Self Service Insurance Master (Q4)• Provide Bulk update, validate and alerting• Allow access to look up and view system reports• Example: Download/misc

WHY

• Complete additional user personas in the web application• Fill functionality gaps between classic version and web application• One step closer to complete general availability• Setup for future self-service functionalities

Q1

Q4

Q3

Q2

Improve Client Efficiency and Experience

TIMELINE

Search

EOB

available

Bulk Claim

Update

Bulk Claim

Validate and

Alerting

System

Report

Access

Self Service

insurance

master

Remittance

lookup

Claims Web Application Biller Enhancements

WHAT

• Editor - Medicare Direct purge, bypass and request eligibility• Editor - Code lookups inside editor • Editor - Edits with KS content links• Bulk Update, Bulk Validate and alerting• Invalid Import processing updates

WHY

• Complete additional user personas in the web application• Fill functionality gaps between classic version and web application• One step closer in complete general availability• Provide additional value to claims and KnowledgeSource product

integration• Allow more flexibility for invalid imports to allow clients to make

more decisions on processing

Q1

Q4

Q3

Q2

Improve Client Efficiency and Experience

TIMELINE

Medicare

Direct

Code

Lookups

Invalid

Imports

Bulk

Update

Bulk

Validate

and

Alerting

Knowledge

Source /

Claim

Validation

integration

Cross Product Integrations

WHAT

• Transition from external third-party to internal screen scraping capability to internal Claim status requests to nThrive’s Clearinghouse Services

• Integration with Claims Analytics and Collections • Contract Management on the radar

• Further integration with KnowledgeSource content with edit correlation. Upstream capabilities in the EMR.

WHY

• Decrease cost to implement and support Claim Status• Create better user experience utilizing analytics• Create better user experience for Collections Management users• Increase client revenue by increasing eligibility and CSA

transactions

Q1

Clearinghouse

Service

(CSA/276)

Collections

Integration

Claims

Analytics II

Q4

Q3

Q2

Knowledge

Source

Claims

Analytics

Claims I

Improve Client Efficiency and Experience

Contract

Management

Reprice

(Market

Assessment)

TIMELINE

CVS/Embedded Claims

WHAT

• Payer-specific Edit Bypass/Inactivation• Partial Claim Editing and Cross Claim Editing (Cerner)• Embedded KPI metrics in Claims Analyzer• KnowledgeSource Edit service integration• Edit Category Mapping Overrides + Field Mapping Updates• Claims Web Integration with CVS portal

WHY

• Additional Edit Self Service capabilities to improve ease of use• Embed edits further upstream for Cerner differentiation (Partial

Editing)• Provide better content to end user via KS integration• Better support capabilities in CVS Portal

Q1

Q4

Q3

Q2

Increase the usability and integration of CVS

TIMELINEPartial

Claim

Editing

HIM Payer

Edits

Cross

Claim

Editing

Portal /

Claims Editor

integration

Payer

specific Edit

inactivation

Portal

Internal

Features

Windows

Server

Migration

Round Trip

Validation

Windows

SQL

upgrade

ON THE RADAR

Pending Market Validation

Denial Probability Scoring

Machine Learning / AI

Automated missing ERA case creation

Machine Learning / AI

Retro Prior Authorization

Robotics Process Automation

Contract Management Claim Repricing

Denials Management Lite

Clearinghouse Payer Mapping and Management

Self Service

*Claim rejection categorization

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Claims Web and Claims AnalyticsDemo

14

Q A&

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