With the emergent prominence of Accountable Care Organizations (ACO) into the healthcare market space, we have expanded our horizons to cater to create customer value and empower innovation for health insurance intermediary services, claims management systems and customer service for an array of insurance types.
Paper claims are collected & segregated separately into States & providers group by the mailroom solutions team. The claims are then scanned & assigned to the claims processing team who adjudicate the claim for payments or denials.
Electronic Claims (ANSI 837I & 837P) are received from professional and facility providers via their respective clearing houses and are scrubbed through Code, Clinical and Coverage edits to eliminate any incomplete or invalid claims out of the system, thereby eliminating the time invested into unprocessable claims adjudication. Clearing houses play a pivotal role in transmitting claim rejection or acceptance reports electronically to the Providers.
We provide solutions for claims re-pricing & adjudication which includes members eligibility verification, provider contract verification required for claims processing, verification of codes to spot bundling issues & duplicate claims. We also audit claims to ensure adherence towards compliance.
We enroll new members, provide customer service where we do financial counseling to help members choose the right plan, we also provide services for screening & conversion of members from Medicare & Medicaid to Managed Care Plans.
Our dedicated Provider Enrollment team takes care of all your credentialing needs. We help you enrol your Group with all the insurance companies along with your individual providers. To ensure smooth cash flow, we facilitate in setting up the Group EDI, EFT and ERA set up with the insurance & follow up until complete to ensure smooth cash flow. We specialize in PECOS (Internet-based Provider Enrollment, Chain & Ownership System) for Medicare enrollments which enhances the enrollment process. We keep track of trends and updates with all the payers to ensure that we are most current in submissions to carriers.
We work hand in hand with our clients to fulfill their requirements in Healthcare, & Pharmaceutical. We provide a wide spectrum of Human Resources Solutions to deliver people with Expertise, Integrity and Accountability. We deliver the best possible match for the client and candidates.