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Coverage Without Compromise: A New Operating Model for DRG Validation

What does a health plan actually gain when it moves from random sampling DRG claims to smart triaging them? Horizon's Ron Jones and Alaffia's TJ Ademiluyi discuss the answer: shorter review cycles, a stronger case for bringing DRG review in-house, and a rigorous test of the approach against sepsis DRG, one of the more contested determinations in claims review.

In partnership with Alaffia Health

Moderator

Author:

Ryan Everist

VP Growth

Alaffia Health

Panelists

Author:

TJ Ademeluyi

CEO

Alaffia Health

Author:

Ron Jones

Senior Director Payment Integrity

Horizon Blue Cross Blue Shield of New Jersey

Read more about Coverage Without Compromise: A New Operating Model for DRG Validation

Reed Willis

Litigation Director

Align Technology

Rebecca Quesnell, Chief Operations Officer/Research & Product Development Director, TransAgra

Include the value your product will bring to animal health and agriculture as a whole….beyond just the buy-in.

Read more about Rebecca Quesnell, Chief Operations Officer/Research & Product Development Director, TransAgra

Shana Kim, Founder, Blovo

In the animal healthcare field, it is important not only to present technological innovation but also to show what meaningful impact your solution can have for pet owners, veterinarians, and the broader care ecosystem. It was helpful to prepare the application with the bigger picture in mind, explaining how our company’s product connects to and influences the overall care ecosystem.