Payer Solutions

Powered by Newton AI

Leveraging our deep IT and healthcare payer
domain experience to solve difficult challenges

Membership Management

Our services help mid-size and large Healthcare Payer organiztions stay flexible in a changing environment and efficiently manage their back-office functions. We specialize in helping our Payer clients with member satisfaction and retention.

Features

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Enrollment and Extraction

Machine learning enrollment and medical record extraction

Pricing

Flexible pricing model with PMPM and outcome based pricing

Adjustments and Coding

Risk adjustment and hierarchical condition category (HCC) coding

Benefits

Financial

Higher STAR ratings and additional reimbursements

Efficient

Maximum member enrollment

Quality

Increased member satisfaction and accuracy of 99% or more

Provider Data Management

Our provider management services steers measurable cost reductions and benefits through multiple aspects:

  • Credentialing services
  • Provider contracting
  • Fee schedule maintenance
  • Provider update and changes
  • Provider data robotic automation

Features

Extraction

Electronic abstraction and validation

Validation

Routine provider data validation

Management and Credentialing

Adhoc provider data management and credentialing services

Benefits

Financial

Measurable cost reductions and benefits

Efficient

Improved process tracking and reporting

Quality

99% accuracy or more

Network Management

ApexonHealth came up with a flexible, scalable solution that helps store the large volumes of provider information, and handle the rich complexities that managing such information entails. We support provider contracting and credentialing, out-of-network claims negotiation support, and fee schedule maintenance.

Features

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Validation

Electronic abstraction and validation

Routine provider data validation

Maintenance

Contract maintenance

Management and Credentialing

Adhoc provider data management and credentialing services

Benefits

Financial

Measurable cost reductions and benefits

Efficient

50% of productivity movement

Improved process tracking and reporting

Quality

Enhanced quality – 99% and above

Claims Administration

We provide solutions for claims re-pricing and adjudication which includes members eligibility verification, provider contract verification required for claims processing, verification of codes to spot bundling issues and duplicate claims. We also audit claims to ensure adherence towards compliance.

Features

Claims Review

100% of claims review using Newton AI‘s predictive claims audit

Flexible models

Flexible sourcing and pricing models

Supportive Process

Supports payment integrity process

Benefits

Financial

Measurable cost reductions and benefits

Efficient

Improved process tracking and reporting

Quality

99% accuracy or more

Learn About Our Risk Free Proof of Concept

Learn about Our Risk Free Proof of Concept