Enhancing Healthcare Efficiency and Access through Claims Processing Modernization and Integrated Services - PROJECT ABSTRACT Project Title: Enhancing Healthcare Efficiency and Access through Claims Processing Modernization and Integrated Services Applicant Organization: Winslow Health Care Center, Inc. Partner Organizations: Dilkon Clinic and Leupp Satellite Clinic Funding Opportunity: FY2025 Indian Health Service Tribal Management Grant Program Project Overview: Winslow Health Care Center, Inc., in collaboration with the Dilkon Clinic and Leupp Satellite Clinic, seeks funding through the Tribal Management Grant Program to implement a transformative project aimed at improving healthcare service delivery across the Navajo Reservation. The project’s primary objective is to replace the current third-party billing vendor with a more efficient and timely PRC Claims Processing and Payment Services system. This modernization effort will optimize financial operations, accelerate claims resolution, and ensure timely reimbursement for Purchased/Referred Care (PRC) services, directly benefiting patients and staff alike. Background and Need: The Winslow Health Care Center, Inc, Dilkon Center and Leupp Satellite Clinic consortium provides vital healthcare services to a geographically dispersed population across rural areas of the Navajo Reservation. Spanning hundreds of square miles, these clinics address significant health disparities and ensure access to essential services for a community often burdened by chronic illnesses, maternal-child health challenges, and limited access to preventive care. Current billing inefficiencies present a major obstacle to maximizing operational capacity, delaying payments, and hindering the timely delivery of healthcare resources. Without these services, residents would face profound barriers, including long travel distances, transportation challenges, and financial constraints, which lead to delayed care, worsening health conditions, and preventable complications. The absence of these facilities would exacerbate chronic disease management issues and maternal-child health disparities, increasing reliance on emergency care and straining regional healthcare systems. Project Goals and Objectives: 1. Modernize Claims Processing and Payment Services: o Replace the current third-party billing vendor with a reliable and efficient PRC Claims Processing and Payment Services vendor. o Streamline claims resolution processes to reduce delays and ensure timely reimbursements. 2. Improve Healthcare Access and Outcomes: o Enhance financial and operational efficiency to increase the capacity of healthcare services at the Winslow, Dilkon, and Leupp facilities. o Provide more timely and consistent healthcare resources, addressing chronic disease management, maternal-child health needs, and preventive care. 3. Support Culturally Tailored Services: o Integrate Navajo language and cultural values into healthcare practices and materials, ensuring trust and engagement with the community. 4. Strengthen Financial Sustainability: o Implement a system that maximizes reimbursement efficiency and reduces administrative burdens, ensuring long-term viability of the clinics. Key Activities: • Conduct a comprehensive evaluation of current billing operations and identify gaps and inefficiencies. • Procure and implement a new PRC Claims Processing and Payment Services system. • Evaluate project outcomes to ensure financial and operational improvements, increased patient access, and better health outcomes. Anticipated Outcomes: • Operational Efficiency: Faster and more accurate claims processing to reduce administrative delays and improve resource allocation. • Enhanced Healthcare Access: Increased availability of timely healthcare services, reducing barriers for underserved populations. • Improved Patient Outcomes: Enhanced chronic disease management and maternal-child health metrics through more consistent and culturally sensitive care. • Long-Term Financial Sustainability: Optimized revenue cycle management to support expanded service delivery
