CitiusTech Inc.

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CitiusTech is a specialist provider of healthcare technology services and solutions to healthcare technology companies, providers, payers and life sciences organizations. With over 2,900 professionals worldwide, CitiusTech enables healthcare organizations to drive clinical value chain - excellence, across integration & interoperability, data management (EDW, Big Data), performance management (BI / analytics), predictive analytics & data science and digital engagement (mobile, IoT).

Realsight - Price Transparency Analytics

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CitiusTech’s Price Transparency Solution - RealSight™ - ingests and curates publicly available Machine Readable Files (MRFs) to provide and end-to-end Data & Analytics Solution for Price Transparency to deliver Payer, Provider & Member Insights. Solution Focus: The “Transparency in Coverage” Rule, that went live on July 1, 2022, required health insurers, group health plans, including self-funded clients, to provide cost-sharing data to consumers via Machine-readable files (MRF). These Machine-readable files provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts. CitiusTech has been among the pioneers, having spent close to two years working on machine readable files through building and implementing our regulatory compliance solution - MRFE (Machine Readable File Engine) for health plans. It is this foundation that’s been instrumental in designing and developing our Price Transparency Analytics solution - RealSight™. Key Business Use Cases: - Optimization and Rate negotiation for network provider - Enable narrow networks & merit-based steerage - Improved Benefit design for insurance products RealSight Key Components: - Enriched Data as a Service: Scalable data platform to ingest and store publicly available MRFs & prepare for analytics - Bring Your Own Data: Isolated cloud platform combining MRF data with enterprise datasets, Operational analytics - Benchmark Reports: BI dashboard & custom reporting: top provider rate benchmarking, service rate comparison - Packaged Analytics Library: Purpose-built dashboards – e.g., network mgmt./ contract negotiation, benefit design - Analytics as a Service: Integrated analytics to existing systems for decision making; Conversation AI solution - Data Quality Scorecard: Scorecard for ingestion of payer MRFs; data quality and profiling measures; monthly trend RealSight Advantages: - Scalable SaaS-based data platform to ingest & store large volume of pricing information from National, Blues and other payers - Monthly curated data from multiple payers in readily consumable format for analytics use cases across payer value chain - Comprehensive data quality checks and standardization to address data inconsistencies, along with clinical equivalence to analyze & extract a larger picture - Flexible architecture to include additional payer domain datasets (claims, quality, membership etc.) for future use cases beyond MRF - Pre-built dashboards for specific payer workflows (network management) that can be further customized per client requirements - Reduced operational cost for payers to host and manage humungous datasets

MRF Engine for Payers

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CitiusTech’s Machine-Readable File Engine (MRFE) is a platform agnostic, turnkey SAAS solution that helps payers accelerate CMS compliance for Coverage Transparency, generating machine readable file with in-network negotiated provider rates. This will empower members to make well-informed decisions about procedures and treatment options, based on prices. Solution Focus: As per CMS Transparency in Coverage Rule, health plans are required to publicly disclose in-network provider-specific reimbursement rates in a machine-readable file. CitiusTech’s MRFE helps health plans generate the mandated in-network file containing payer and provider negotiated coverage rates. Key Features: Highly Scalable architecture: Process large volume of data with complex and iterative business rule(s) Configurable and Modular: Enables ease of customization and enhancement Auditability and Transparency: Granular and detailed logging & notification framework MRFE can further enable Health plans with: Faster implementation of personalized cost estimator tool Unified view of negotiated rates enabling analytics for value-based payment models Optimization of provider network management with market insights Handle schema changes by CMS Monthly updates to MRF files Health plans can Improve member experience by providing: Easier access to costs across in-network providers enabling informed decisions Increased transparency that will influence competitive pricing and reduce overall costs