Claims Management
- Healthcare Solutions
- Interoperability
- Implementations
- Healthcare BI/ DW
- Disease/ Wellness Management
- Claims Management
- Mobile Solutions
- Certification & Meaningful Use
- HIPAA 5010 Transition Services
- ICD-10 Transition Services
- Healthcare Data Management
Health plans continue to invest in their claims systems focusing on automation of healthcare claim processing to improve turnaround time and claim throughput.
Changing regulatory standards are forcing healthcare payers to make considerable investment not only in building new systems, but also in focusing on integrating it with provider and third party system for faster claim processing, and thus increasing the rate of electronic claim submission.
Having partnered with multiple healthcare payers and revenue cycle management companies we understand the challenges involved in the claim management space and help you address newer challenges while increasing the efficiency of claims processing.
Our years of experience working dedicatedly on US healthcare space has helped us offer a range of solutions such as revenue cycle management, health insurance claims processing, over-payment analysis, and QA automation.
Services
Leveraging our experience in claims management we offer a range of services:
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Consulting
- Claim process re-engineering
- Legacy modernization for claim re-platform
- New system implementation
- Regulatory compliance consulting
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Technology
- Building and maintenance of claim management platform
- Customizing package products like Trizetto facets
- Development and testing of new claims system
- Integration with third party system
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Operations
- BPO services for over-payment analysis
- Eligibility verification
- Claim adjudication services
- Advanced BI and analytics
- Data management services
- Medical authorization review
- Co-ordination of Benefits processing
Benefits
- Expert inputs from our healthcare CoE to improve the quality of the process
- Our SMEs and healthcare technologists having knowledge on claims management ensure easy on boarding and faster knowledge transfer
- Repository of claims analysis scenarios and test cases
- Development framework for Business Intelligence platform for claims data analysis
Case studies
- Implementation of auto adjudication tool for a leading payer
- ETL and BI services for claims data analysis for a leading RCM organization
- Technology migration of claim administration product for a leading payer
- Build, test, and operate an automated erroneous claims detection system for a US top-3 insurance processor
- DBA support to a large claims processing system for a leading cost management services company
- QA automation for a revenue cycle management company