Appropriately determine risk based on contractual assignment

Reduce gray areas for assignment of risk

Easily define and configure individual Division of Financial Responsibility (DOFR) contractual relationships.

Determining which party is financially responsible for services rendered is notoriously time-consuming and complex. The QNXT DOFR Module simplifies this process with a set of tools to easily define and configure individual Division of Financial Responsibility (DOFR) contractual relationships. This means they can be quickly and accurately analyzed and acted on during the claims adjudication process, and that claims can be paid by line of business, based on the DOFR. It also reduces gray areas in defining which party has risk for a specific service. Features include:

• Allowing users to configure any defined DOFR
• Permitting intake of the assigned DOFR during the QNXT adjudication process
• Allowing for DOFR override when authorized by the health plan or medical group
• Providing high-quality measures, outcomes and reports
• Supporting cost containment and cost certainty

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