Payers
Healthcare payers and related entities such as third party administrators, clearinghouses, and health information exchanges, are seeing the current changes and trends in the industry.
CIO of a $300M Healthcare Company
" ...The experience has been extremely productive and positive. emids has done a tremendous job. They have assembled a team of competent and hard-working professionals in India to expand our technology team and broaden the scope of work we can deliver. The customer service is equal to or even superior to past outsourcing efforts on-shore. The fact that emids is in Nashville is a Plus. We see our emids team at least once each week. That face-to-face opportunity is a key to our shared success... "
- Regulation changes
- HIPAA 5010 transition
- ICD-10 transition
- Stringent reporting
- Audits
- Demand for predictive analytics and business intelligence (BI)
- For optimizing cost and quality of care
- Better wellness and disease management
- Business processes changes in
- Claims administration
- Benefit management
- Contract management
- Member management
- Utilization management
- Disease/wellness management
emids services and solutions for health plans span across, indemnity - fee for service; managed care - HMO, POS, PPO and EPO; government sponsored - Medicare and Medicaid; consumer driven - FSA, HSS, HRA, and Blue Cross & Blue Shield plans.
Services and solutions
emids provides services and solutions for payers to help them in:
- Customizing and building solutions across claims administration, utilization management, point of enrollment, member and provider management, and accounting systems
- Building BI capabilities to their claims management systems for effective overpayment analysis, wellness and disease management, and quality reporting
- Providing overpayment recovery, claims adjudication, eligibility verification and CMS validation services as part of our business process outsourcing offering
- Providing HIPAA 5010 and ICD-10 business testing services
- Technology migration and re-architecture
- SaaS and cloud computing enablement of member and provider management applications
Benefits
- Automation in payer processes and systems
- Cost contained delivery of IT system development
- Specialized healthcare knowledge resources for implementing standards for compliance like meaningful use, HEDIS reporting, HIPAA EDI, ICD 10
- Integration with healthcare exchanges and enterprise systems
- Better business intelligence and decision making
- Easier adoption of newer technology, leading to better patient experience
| emids expertise spans across development, testing and implementation in the following sub-segments |
|---|
| Wellness and disease management system |
| Claims management system |
| Provider contract management system |
| Point of enrollment and member management portals and systems |
| ICD 10 transition services |
| HIPAA 5010 business testing |
| Payer BPO – Adjudication, analytics, eligibility verification, overpayment analysis, CMS validation, recovery services |
Case studies
- Development and QA of PoE application for a leading payer
- Implementation of auto-adjudication tool for a health plan
- Data migration for multiple clients to a single wellness management platform
- Build, test, and operate, an automated erroneous claims detection system for a US top-3 insurance processor
- Automated testing process for radiology necessity verification for a radiology benefit management company
- Technology migration of claim administration product for a leading payer