Skip to Primary Navigation Skip to Site Navigation Skip to Main Content
Who We Help

Payers

  • As a payer, how is your organization dealing with claim adjudication?
  • Are you creating pay-for-performance (P4P) opportunities?

Today, P4P and value based purchasing and transparency are on everyone's mind. 3M tools and services help payers focus on payment and reporting using readily available claims data. The resulting information can help payers manage quality and costs in a P4P environment. Once implemented, 3M solutions track and report on services provided and give payers the information they need to collaborate successfully with providers in structuring an equitable P4P system.

How 3M Helps

  • Convert claims data into powerful tools for addressing undesirable complications and readmissions
  • Provide tools for effective risk measurement and adjustment
  • Design clinically precise tools for disease management, provider profiling, and outcomes measurement
  • Improve your payment methodology to achieve better alignment between payment incentives and clinical outcomes

Download Solutions for Payers (PDF, 474 KB)

What 3M Offers

  • Inpatient Solutions

    • 3M™ Potentially Preventable Complications (PPC) Grouping Software allows a health plan to identify complications that may have been avoided. Using sophisticated clinical logic, the 3M PPC Software first identifies conditions not present on admission and then determines whether those conditions were potentially preventable given the patient’s reason for admission, procedures, and underlying medical conditions. 3M PPC Grouping Software also flags Hospital Acquired Conditions monitored by CMS. Consider rewarding providers in your network for addressing and reducing preventable readmission rates.
      PPCs for Payers (PDF 154 KB)
    • 3M™ Potentially Preventable Readmission (PPR) Grouping Software is a batch grouping application that identifies readmissions which are potentially preventable by means of the powerful 3M PPR clinical methodology. The 3M PPR clinical logic determines whether a readmission is clinically related to an oversight from a previous admission. PPRs may be used for payment incentives or quality reporting.
      PPRs for Payers (PDF 197 KB)
    • 3M™ All Patient Refined Diagnosis Related Groups (APR DRGs) Software is an inpatient classification tool that creates a severity-of-illness (SOI) score and a risk-of-mortality (ROM) score for all population groups. This tool provides a uniform process for qualifying the clinical differences in inpatient populations. Over the past 10 years, 3M APR DRGs have become the most widely used, non-Medicare severity adjusted tool in the United States. They have been used as the basis for payment systems as well as quality reporting processes. 3M APR DRGs are the basis for successful pay for performance programs.
      To read more about 3M APR DRGs, click here.
      APR DRG for Payers (PDF 209 KB)
    • 3M™ Clinical Claims Editor (3M CCE) is an application that allows payers to evaluate claims submitted by providers for accuracy and completeness to generate the appropriate DRG assignment.
      To read more about how 3M CCE can help you, click here.

  • Outpatient Solutions

    • 3M™ Enhanced Ambulatory Patient Grouping (EAPG) System is an outpatient grouping tool that outlines the parameters for an outpatient prospective payment system by identifying the key procedures for ambulatory visits. The 3M EAPG System may be used for reimbursement or quality reporting.
      To read more about the 3M EAPG System, click here.
      Enhanced APGs for Payers (PDF 247 KB)
    • 3M ™APC Grouper Plus Software for the z/OS Mainframe (with the APC grouper and Outpatient Code Editor) is designed to group claims and calculate prospective reimbursement according to the Centers for Medicare and Medicaid Services (CMS) requirements for the outpatient prospective payment system (OPPS). The 3M software provides the necessary edits to help improve coding accuracy, completeness, and consistency.
      To read more about APCs, click here.

  • Episodes of Care: Solution for Both Inpatients and Outpatients

    • 3M™ Clinical Risk Grouping Software (3M CRGs) an episodic grouper, is a risk adjustment management tool used to track all episodes of care and project future use of medical services. 3M CRGs may be used for contracting, disease management, provider profiling, and measuring or improving quality of care and outcomes. Payers may use 3M CRGs to align payment incentives with clinical goals.
      To read more about how CRGs could help you, click here.
      CRG Solutions for Payers fact sheet (PDF 25.6 KB)

    • For over 25 years, 3M Health Information Systems has offered innovative solutions to help payers effectively manage their provider relationships as well as accurately track and monitor member populations and their encounters with the healthcare system. 3M solutions have delivered information on resources used, quality reporting and outcomes, and claims management, and also helped build the foundation for partnerships with providers in a win-win environment.

    For more information, call 800.367.2447 or click here.