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Johns Hopkins Health Plans moves deeper into AI applications with partnership to support members comply with the No Surprises Act.
By implementing InsightPro from MDI NetworX, Johns Hopkins Health Plans (JHHP) is addressing what it sees as a problem with the No Surprises Act: While the law provides patients with transparency and protection against surprise bills, it also introduces modern compliance requirements that Johns Hopkins says have gotten many health plans into trouble.
Ryan O’Donnell, chief operating officer of Johns Hopkins Health Plans, called the technology “innovative” and said it will give members access to exact and up-to-date provider information and escalate trust in the company’s services.
WHAT ARE THE EFFECTS?
The company said its AI-powered analytics platform has already delivered significant benefits to Johns Hopkins Health Plans.
First, it provided timely updates to provider directories, which resulted in improved transparency for patients and minimized billing confusion, according to JHHP. It also provided progress tracking and quality assurance capabilities to reduce directory errors.
The organization added that the technology has reduced the number of claims indicating incorrect member cost-sharing, which translates into better member service and less tension between members and service providers.
“As a managed care organization administering government programs, compliance with laws and regulations is essential,” said John Wells, executive director of compliance for Johns Hopkins Health Plans. “Technology that reduces errors and improves quality assurance makes us stronger for those we serve.”
JHHP started we are entering the AI payer space earlier this year, when it launched a modern multi-payer portal to connect providers and payers. Using the real-time, AI-powered platform, provider offices will be able to submit and track electronic claims, claim status, remittance information, and claim payments, according to Johns Hopkins. It helps providers with insurance claims and pre-authorization requests.
An AHIP study released earlier this year found that in the first nine months of 2023, the No Surprises Act protected Americans from more than 10 million in unexpected medical bills.
BIGGER TREND
Johns Hopkins Health Plans administers provider-sponsored health plans based on Johns Hopkins Medicine’s clinical research.
As a joint entity of Johns Hopkins Health System and Johns Hopkins University School of Medicine, Johns Hopkins Health Plans serves nearly 450,000 members in Maryland and the Mid-Atlantic region.
Johns Hopkins Health Plans has four health plans: US Family Health Plan, Employer Health Programs, Priority Partners, and Advantage MD. It manages more than $3 billion in annual premiums.
He also leads the Solutions and Innovations venture in collaboration with Johns Hopkins faculty and vendors, transforming research and ideas into digital products, including analysis of the health status of the population software called Johns Hopkins ACG System.
Johns Hopkins Medicine, headquartered in Baltimore, has six teaching and county hospitals, four suburban health and surgical centers, more than 40 patient care locations, a home care group and an international division.
is the editor of Healthcare Finance News.
E-mail address: jlagasse@himss.org
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