Payor Services

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.

Some of our distinctive payor solutions comprise of the following:

Mailroom Solutions

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.


Data Conversion

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.


Claims Processing & Adjudication

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.


Member Enrollment and Eligibility Services

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.

2017 © MiraMed Ajuba International LLC. All Rights Reserved.