Health Mason software to streamline health care claim payment process

Nov 17 2009

With health care reform taking the national spotlight, the sole point of agreement by all parties is that some form of change is necessary. Many health care industry experts believe that now is the worst time for government-mandated change because innovation has already begun to occur organically from within the industry. One Franklin Tennessee-based software company is defining that innovation and garnering attention in the industry.

Health Mason is the solution to the labor intensive, inefficient, and error prone process of health care claim payment. Health Mason is the first product to automate this process from beginning to end and simultaneously accommodate the frequent contract and compliance changes in the industry that has stymied past software solutions. The CEO of Linnaeus and creator of Health Mason, Sal Novin, describes Health Mason as a product that can emulate the work of a human claim examiner. "Health Mason reads a computer screen, it types in data, and decides how to perform a given task with no additional help or tools." But not only does it replicate the work of a human operator, it performs every process with the same mechanical precision as the last, dramatically decreasing human error and increasing quality.

Still, Health Mason's most jaw dropping feature is its raw performance, which is the stuff of science fiction. Novin attributes Health Mason's performance to a technical concept called "multi-threading." Each thread or instance of the application is like a super-human operator reading, typing and deciding the best way to process a health care claim at 3 to 10 times the speed of an average operator. Each thread works relentlessly 24 hours a day, without the need for breaks, food, or sleep - pausing long enough only for nightly backups and other system related tasks. Multi-threading means that adding "staff" is as easy as adding more items to a shopping cart on Amazon.com - no hiring, no training, and no overhead. Each new thread is a clone that processes as effectively and efficiently as the last.

Novin describes the creation of Health Mason as a case study in good old fashion American ingenuity - having come up with the concept to overcome an unprecedented claim backlog for a health insurer. The conventional solution was to hire temporary staff to clear the work load; however new staff had very little health care experience. The result was the introduction of new errors that were even harder to fix. The result was a solution that Novin had used previously while working in the financial sector, which was to simulate human input into a system. Employing that technique was significantly harder in health care, but the result became the underpinnings for a solution that was able to perform in two weeks what a 30 person department of examiners could not accomplish in a month. Today, the latest version of Health Mason can complete the same task in 50 hours.

The latest advancements in Health Mason's logic have been to its decision-making capabilities. Health Mason draws much of its capabilities through a proprietary, health care-specific software scripting language. The scripting language codifies common health care decisions to enable rapid automation of manual processes. Most recently, Health Mason was required to audit claims - a significantly more complex task than claim editing or examining. The new scripting language was augmented to handle very sophisticated decisions.

The Linnaeus team has leveraged all these technological advancements to break from convention when it comes to health care technology in general. Novin added, "We set out to change all the negative health care software preconceptions, by making implementation time a few weeks, delivering direct one-to-one savings through a simple transaction model, and make the harder to quantify performance and quality improvements a free value-add."

Health Mason still must face the uphill battle of broad acceptance. Mr. Novin is confident that the Linnaeus team is up to the challenge. "There are scores of executives and operations teams who have been burned by technology. Our goal is to target the 'guts' and not the 'glory' of operations and win over new health plans and providers that are in real need of productivity savings."