Our Payer Business Solutions offerings assist insurance companies in effective customer enrolments, policy administration, billing and collections, rating and underwriting, benefits validation and claims management.
Our core insurance solutions offer customer centricity, risk management, compliance and business IT efficiencies. The core insurance solutions focus on reducing costs, time to market, increasing revenue and complying with the regulatory requirements.
Our industry solutions focus on the following areas:
Our Customer Enrolment solution offering enables health payers to reduce the enrolment cost and increase efficiency. Also, our high-end technical and functional expertise enables health payers to easily rollout e-enrolment initiatives.
Our Rating and Underwriting service offering helps to deliver web-enabled rate quote and automated underwriting systems. The offering helps to reduce manual intervention, increase rate quote accuracy, and decrease turnaround time and manual errors. This, in turn, helps to improve customer satisfaction.
The offering also assists the health payers in managing denials, exclusions, preexisting conditions and premium calculation for the members.
Our Core Policy Administration service helps to provide efficient customer service and policy administration at reduced costs to the Health Payers’ end-customers. The offering helps to reduce manual intervention and improves data maintainability and accuracy.
The offering also ensures that the health payers gain competitive advantage, enhance customer service and improve business performance.
Our Integrated Policy Management framework enables the Health Payer organizations to manage the entire policy lifecycle.
Our Billing and Collection offering focuses on improving the revenue cycle of Healthcare Payer and Provider organizations. The offering ensures that the payer issues payments and benefits appropriately and on time. Also, the offering ensures that the providers are reimbursed acceptably for the services rendered.
In addition, the offering enables the payer organizations to track and maintain the cash flow. The offering not only deals with the premium requests but also links the premium to the accounts receivable.
Our Benefits Validation offerings help to automate the manual benefit validation process. An integrated platform for communication is available to the providers, members and internal processing staff. The communication platform is used to streamline the complex business processes.
The Claims Management offerings enable the Healthcare Payer organizations to manage the claims life cycle, from provider submission to claims re-adjudication.
Our Pharmacy Benefit Management offerings help large healthcare payer organizations to streamline pharmacy and pharmacy benefits processes. The offerings help to achieve Health Insurance Portability and Accountability Act (HIPAA) and other regulatory compliances.
Also, the offerings support customers to:
- Develop and manage formularies
- Integrate and automate pharmacy claims processing systems
- Manage mail order prescriptions
- Develop Electronic Data Interchange (EDI) interface for electronic claims