Healthcare Invoice Validation

Invoice validation ensures that commissioners pay the right price to their healthcare providers for activity that is of high quality and to agreed care pathways and protocols. Timely and accurate information is critical to ensure that commissioners and providers are able to agree activity and payments to the agreed Payment by Results timescales   Transactional costs for NHS organisations have increased dramatically, but through automation of data reconciliation activities, local analysts can spend their time on exception reports that are focused on improving the quality of care provided to patients.

Our Approach:

Health Intelligence can act as an ‘honest broker’ for commissioners and providers, applying mutually agreed clinical and financial rules to activity data that reduces transactional costs for all participating organisations.  Rules can reflect national policy and NICE guidance and also incorporate local requirements such as Effective Use of Resources (EUR) policies.  Through the secure linkage of provider activity with GP Practice clinical and referral data we are able to ensure that patients receive the treatment required for their condition and able to support the improvement of care pathways including the referral and discharge process.

Key Features & Benefits

Through our CDRIntell broswer-based application, we replace manual processing of Commissioning Data Sets (CDS) and are able to apply complex validation rules that exception report activity that requires manual review.  These browser browser-based reports are grouped under different headings for different users ensuring that only those areas that require clinical review are sent to clinicians whilst areas that require administrative review can be reviewed by non-clinical staff.

Example groupings include:

Activity that requires administrative review:

• Duplicate appointments or hospital events
• Inappropriate age for procedure
• Patients seen privately
• Not registered patient on date of event
• No hospital correspondence received

 Activity that requires clinical review:

• Unexpected procedure, specialty or HRG code
• Unexpected length of stay or admission rates
• Consultant to consultant referrals

Benefits to Commissioners and Providers

• Opportunities for savings from the commissioning budget and identification of service gaps can inform commissioning priorities
• Accurate and timely contract performance information allows for more accurate forecasting of future service use and provides opportunities for providers to grow healthcare services in line with patient needs
• Monitoring of compliance to agreed clinical pathways and identification of areas for improvement
• Actively encourages and supports engagement in care pathway re-design
• Poor or missing data is efficiently reported
• Improved quality and accuracy of a high volume invoice validation process increases confidence in challenges whilst reducing transactional costs
• Analysts are able to focus on quality of care issues rather than the reconciliation of datasets
• Measurement of quality and outcomes of care pathways through linkage of datasets