Highmark Implements Babel Health Solution for Improved Medicare Advantage Submission Results

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With Babel Health, Highmark can work through RAPS and EDPS encounter submissions on the same platform. This eliminates the need for two systems with duplicate data, and provides real-time visibility into the data and quick problem solving.

Babel Health, Inc. — provider of the first fully integrated platform for risk adjustment encounter submissions — is pleased to announce that Highmark Health has implemented the Babel Health solution for their RAPS and EDPS submissions.

Highmark — the fourth-largest overall Blue Cross Blue Shield-affiliated organization, covering the insurance needs of 5.6 million members in Pennsylvania, Delaware, and West Virginia — partnered with Babel Health to improve workflow and program efficacy, align their data, increase their submissions, while continuing to maintain full compliance. Before Babel Health, Highmark utilized an in-house approach that required following multiple processes on separate information systems for EDPS and RAPS submissions. “The need to simplify our processes and better leverage our resources was the driving force that led to finding a solution that streamlines our submissions and continuously improves quality,” said Olga Ziegler, VP, Revenue Program Management at Highmark.

With Babel Health, Highmark can work through RAPS and EDPS encounter submissions on the same platform. This eliminates the need for two systems with duplicate data.

The Highmark team also desired to improve performance. “We had an ongoing need to advance processes to improve how we measure results,” explained Ziegler. “Real-time visibility into the data, balancing between RAPS and EDPS, and quick problem-solving is crucial to ensure accuracy and completeness of submissions.”

The Babel Health solution gives Highmark’s risk adjustment team direct access to all pre- and post-submission errors, a clear explanation of each error, and a state-of-the-art workflow tool to correct those errors — with no need to engage the claims vendor. No other vendor offers this level of transparency.

Highmark also wanted to ensure that claims didn’t end up in a “purgatory” where they were neither rejected nor accepted. “Eliminating these unknowns impacts performance and reduces operational expense,” added Ziegler. “Any lag in making corrections and confirming submissions is not acceptable. With Babel Health, we know the status of all our submissions and, more importantly, we can ensure all appropriate submissions are sent to CMS.”

Babel Health’s primary focus is the submission process — the last line of defense before an encounter is uploaded to CMS. This was another key reason Highmark decided to adopt the platform. “Unlike other vendors who offer a wide range of services, Babel Health is laser focused on full transparency of risk adjustment data submission management, versus other companies where the submission is a “black box,” said Ziegler.

“As we see changes in regulations and the introduction of new products, it is crucial that we continue to improve the workflow and maintain compliance,” noted Ziegler. “Having a user-friendly system that enables accurate and complete data submission to CMS makes this possible.”


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Robert J. Dunn
Babel Health
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