GHA Payer Scorecard Pilot Program Project Overview Webinar On Demand-GHA Payer Scorecard Pilot Program Project Overview Recording

Video Transcription

Video Summary

GHA hosted a members-only webinar announcing a two-year Payor Scorecard Pilot Program in partnership with Hive Health. Blake Fullenweider (GHA) explained the initiative responds to severe hospital financial pressures and growing payer tactics such as denials, prior authorization burden, downcoding, slow payments, and unilateral policy changes. GHA needs timely, credible, statewide data—beyond anecdotes and outdated snapshots—to support legislative and regulatory advocacy and strengthen hospitals’ negotiating position.<br /><br />Rather than a costly survey approach, Hive’s platform (Vitality) ingests hospitals’ 837 claims and 835 remittance files to generate de-identified, transactional analytics. Participating hospitals get operational insights for revenue cycle and managed care, while GHA receives aggregated, de-identified benchmarks to quantify denial trends, administrative burden, and payer-specific patterns across Georgia.<br /><br />Hive CEO Travis Gentry demoed benchmarking features: prompt pay, first-pass yield, denial categorization using CARC/RARC crosswalks, downcoding detection, reimbursement/allowables, and drill-downs by payer type, specific payer, inpatient/outpatient/ED/observation, and specialty. Q&A addressed analyses by claim size, payer mapping (including Blue plans), and confirmed access is limited to data-contributing hospitals.<br /><br />GHA will email a non-binding statement of interest and pilot details, with responses requested by Feb. 13; the recording will be posted to GHA’s Learning Academy.

Keywords

GHA Payor Scorecard Pilot Program

Hive Health Vitality platform

hospital claims analytics (837/835)

payer denials and prior authorization

revenue cycle and managed care benchmarking

CARC/RARC denial categorization

prompt pay and first-pass yield metrics

Georgia statewide payer performance data