Claims Management

Our claims BPM and KPM services lead to significant reductions in cost and TAT (turnaround time) through integrated process redesign and technology innovations. Our paper to EDI conversion, combined with repricing and our rule-based auto adjudication support service, helps payer clients further cut down on cost. Our deep understanding and evaluation methodology of medical claims and contracts enable payers to save money through identification of overpaid claims.

Maximizing accuracy at every point in the claims payment process is essential if payers are to compete. We maximize accuracy for our clients.

Case Studies
Risk Score Optimization through CDI
Scope: A major university-based health system wanted a thorough review of their documentation to see if it was supporting the level of care they are providing to the risk adjusted patient population.
Provider Data Management - Process Innovation and Technology Result in Cost Savings
The Challenge: A cost intensive update process required checking data on all provider information update forms, rather than the ones which were actually changed (typically only 40%).