- Moving to
New Billing system?
- Stuck With
- High / Aged
Payor ServicesWith 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:
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.
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.