Claims Administration
Leveraging the power of artificial intelligence to create breakthrough improvements in pre and post claims payment.
Manual Touch Reduction
- Insightful data patterns
- Improve team allocation
- Robotic Process Automation eliminates data silos
Claims Audit
- Evaluates 100% of processed claims
- Predictive algorithms flag claims based on error propensity
- Improvement in Quality Scores
%
Reduction in manually adjudicated claims
Times lift in revenue leakage identification
Membership Management
Providing an artificial intelligence-driven back office to help Payer organizations efficiently manage their operations. We specialize in helping our Payer clients with member satisfaction and retention.
Features
Enrollment and Extraction
Pricing
Flexible pricing model with PMPM and outcome based pricing
Adjustments and Coding
Benefits
Financial
Higher STAR ratings and additional reimbursements
Efficient
Quality
Increased member satisfaction and accuracy of 99% or more
Provider Data Management
Delivering measurable cost reductions and benefits.
- Credentialing services
- Provider contracting
- Fee schedule maintenance
- Provider update and changes
- Provider data robotic automation
Features
Extraction
Electronic abstraction and validation
Validation
Management and Credentialing
Benefits
Financial
Efficient
Quality
Network Management
Scalable solutions that help store and manage large volumes of provider information. We support provider contracting and credentialing, out-of-network claims negotiation support, and fee schedule maintenance.
Features
Validation
Electronic abstraction and validation
Routine provider data validation
Maintenance
Management and Credentialing
Benefits
Financial
Efficient
50% of productivity movement
Improved process tracking and reporting
Quality
