Nivano Physicians Maximize Revenue and Achieve Operational Goals with Claimshop Web Services Integration

By nThrive | Posted: 11/11/2020

Health care technology partnership

Based in Sacramento, California, surrounding 11 county regions, Nivano Physicians, is the leading provider of coordinated managed care services for both Medi-Cal and Medicare patients. Today they serve more than 75,000 active members in those surrounding counties. As change in healthcare is always a constant, Nivano Physicians today announced it has partnered with nThrive and its software, Claimshop (Medicare Grouping & Pricing edits) to help the California-based independent physician association (IPA) enhance their current administration platform.

Claimshop seamlessly integrates with QuickCAP™ 7.0, Nivano’s existing health benefits management solution created by software developer MedVision. Nivano wanted to ensure their positioning strategy was on track while entering into global risk agreements and CMS’s newest DCE models and to meet varied pricing methodologies around complex DRG / APG requirements.  

The vision of Sarath Artham, CEO of Nivano Physicians, was to augment their already advanced use of technology of MedVision’s care coordination, eligibility & population health management, utilization review, claim adjudication, customer service, and various financial and analytical aspects in the healthcare payer markets. This is what led Mr. Artham to a partnership with nThrive for Claimshop. 

The unified automation approach of Claimshop and QuickCap helps payors achieve measurable savings associated with repricing and claims flow automation, HIPAA-compliant electronic data interchange (EDI) programs, and contract management and modeling. Claimshop also allows payors to manage and track claim communication with their providers and other trading partners efficiently and securely.

Some other benefits experienced by Nivano Physicians’ combined strategy include:

  • Reduce or eliminate initial startup costs
  • Increase savings through reduced repricing costs
  • Identify improper or inaccurate claim coding
  • Improve reinsurance recoveries
  • Improve contract management efficiency
  • Automate repricing of the most difficult hospital and ancillary claims
  • Increase repricing accuracy dramatically
  • View pricing and track routing through the entire claims flow process

“Our seamless integration of QuickCap with nThrive’s Claimshop provide all Medicare proofing and pricing methodologies, and edits for our technical component agreement segments all in one service,” says Artham. “Other vendors charge differently per methodology, provide separate invoices for each, and require individual integrations. Now, with one integration point and one comprehensive invoice, we can improve efficiency and manage revenue through accurate and compliant pricing.” 

About Nivano Physicians

Nivano Physicians is an Independent Physician Association (IPA) operating within Sacramento and surrounding counties. Nivano Physicians is a strong and committed advocate for the Medicare and Medi-Cal community--ensuring that managed health care is actually 'manageable.' The IPA educates and advises clients and physician participants and oversees their members’ managed health care needs. www.nivanophysicians.com

About nThrive

nThrive's partner solutions help payor and provider technology vendors, healthcare services companies, medical billing companies and consultants create a strategic advantage by enhancing their technology and services without large investments in development and ongoing management.

Visit nthrive.com/partners to learn how nThrive’s partner solutions can enhance your healthcare technology applications and services.

About MedVision

MedVision, Inc. is an innovative software solutions provider to the healthcare industry of intuitive and integrated products to help organizations operate efficiently and provide them with a competitive advantage. MedVision’s flagship product, QuickCAP v7.0, is a complete health benefits software solution that leverages advanced technology to automate workflow, enable superior analytics, integrate business processes and improve patient outcomes, while reducing operating costs.