Optimizing Your Clean/Risk Sort
What is the benefit of implementing a clean / risk sort for primary source verification results?
Allows expedited committee process. The results of the clean risk sort allow plans to move the group that is designated as “clean” straight to committee without any additional review. The group designated as risk can be, depending on the client’s required risk elements, can indicate what follow up the plan might need
How does implementing a clean / risk sort increase efficiency for Aperture’s clients?
The clean risk sort will call out exactly what the plan identifies are risk factors, and by using this clean risk sort, it will help them to identify quickly who has a risk factor. Without a risk sort, it would require the health plan to go through entire PSV packet and identify what is or isn’t risk. The clean risk sort is doing all that work for them
Does implementing an automated clean / risk sort eliminate the manual, paper-heavy process for committee review?
It can. If we have a plan’s file processing requirements, we can apply those same requirements to the clean group. Once they receive the file back in that group, it means that the file could go straight to committee, eliminating extra paperwork. This could also be applied to risk categories. Based off of what they determine “at risk,” that file could be processed to client immediately, allowing them to take the file straight to committee without having to do extra research or paperwork.
What categories are available in the Aperture clean / risk sort?
PSV elements we have today. We can sort clean or risk based off of all our PSV elements. Whatever is usually in standard elements packet the client receives, we can use the system based off the plan’s file processing requirements to determine if that file needs to go clean or risk. For malpractice insurance, for example, there are some states that have specific limits. WE can apply those elements to that malpractice section.
How much prep time is saved by utilizing the Aperture clean / risk sort?
Differs depending on plan’s committee process. If they have a committee process that they can say that any file that comes in is strictly deemed clean can go straight to committee, or they have process where files are deemed risk can go straight than they can be.
Does Aperture’s clean / risk sort allow clients to sort provider information in a way that works best for the client committee process?
When we’re using what the plan wants us to look at – yes it does.
Does Aperture’s clean / risk sort streamline Aperture’s client committee review meetings?
Yes. Using client’s requirements on how to determine which PSV element would drive files risk or clean, they would be able to take those clean files straight to committee, without doing extra prep work. Requirement elements. If you have three elements that come back risk and are not allowed into the network, you are still able to move those through to the committee to be reviewed.
Does Aperture’s clean / risk sort eliminate time-consuming manual task while decreasing risk and improving quality?
It can reduce time if we are evaluating all the elements for that client that will determine whether that provider can get into their network. Without using Aperture’s clean risk sort, a client must go through CDT and check entire profile manually based on their requirements. If that same client gave us their checklist they usually do manually, and we apply it to our automation, our system identifies files and reduces time-consuming manual tasks.
For clean risk sort, the most important thing would be to establish a standard element requirement before any customization is done. It is best for clients to use our standard and close files over 90 days. After the 90 days, we can evaluate what else is needed.