Member Management

Our member enrollment services reduce the administrative burden and cost to support member enrollment processes. Our eligibility and benefits configuration, backed by our knowledge-based platform, addresses the industry problem of inaccurate benefits configuration. This leads to reduction in improper claim payments and a decrease in appeals and grievances.

Blog

5 Ways Healthcare Organizations Benefit from Remote Coding

Healthcare organizations require a high degree of accuracy in medical coding in order to keep their revenue cycle management systems running smoothly. From ensuring compliance with state and federal regulations, to making sure that reimbursements are paid on time and to the maximum, medical coding is the backbone of every healthcare organization’s financial health, whether it’s a small physician group or a large hospital.
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%).