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
Claims Management - Process Innovation and Technology Result in Cost Reductions
The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data.
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%).