Health Care (Group and Individual) Insurance
Property & Casualty Re/Insurance
⇒ Stay Ahead in Health Care Insurance Trends
⇒ Adapt your strategies to navigate today’s shifting health care insurance landscape
⇒ Harness cutting-edge technology to enhance claims management and patient satisfaction
Member Services
Our member services help health insurance providers manage enrolment, eligibility verification, and ongoing customer support. We ensure smooth onboarding, accurate benefits administration, and high-quality customer interactions to improve member retention and satisfaction.
Enrolment & Eligibility Verification
We handle member enrolment processes and verify eligibility for health benefits, ensuring smooth onboarding and continuity of coverage.
Comprehensive Customer Support
Our team provides round-the-clock support, addressing member inquiries, clarifying coverage, and resolving issues quickly and efficiently.
Plan Benefit Administration
We manage benefits administration, ensuring accurate plan management, claims processing, and communication of benefit details to members.
Payer and Provider Services
We bridge the gap between payers and providers, offering credentialing, network management, fee schedule management, and benefit administration operations. These services ensure a well-functioning payer-provider relationship, enhancing the quality of care and payment accuracy.
Provider Credentialing
We handle the credentialing process, ensuring that providers meet required standards and are properly documented before joining the network.
Fee Schedule Management
We manage fee schedules, ensuring accurate and up-to-date pricing for medical services, reducing billing discrepancies.
Provider Network Management
Our team manages relationships with providers, ensuring smooth network operations and consistent provider engagement.
Benefit Administration Operation
We oversee benefit operations to ensure consistent and compliant benefit delivery across payer networks.
Utilization Management
Our utilization management services help insurers monitor and control healthcare costs by ensuring that medical treatments and services are necessary and covered under the policy. This promotes effective cost management and ensures policyholders receive appropriate care.
Pre-Authorization Services
We manage pre-authorization requests to ensure treatments and services meet policy guidelines before they are rendered.
Comprehensive Case Management
Our case management services monitor complex cases, ensuring members receive appropriate care while optimizing healthcare costs.
Chronic Disease Management
We support chronic disease management by coordinating care, managing treatment plans, and optimizing outcomes for patients.
Claims Processing
Our comprehensive claims processing services ensure accurate and efficient handling of health insurance claims. We streamline the entire lifecycle, from claims submission to adjudication, coding, and payment processing. This reduces turnaround times, minimizes errors, and enhances customer satisfaction while ensuring compliance with regulatory requirements.
We thoroughly review and assess claims for coverage, eligibility, and policy terms, ensuring accurate processing and fair payouts.
Our team uses standardized coding systems like ICD-10 and CPT to ensure proper coding of medical procedures, diagnoses, and treatments, minimizing errors.
We manage the entire billing process, ensuring prompt and accurate payment to providers and clear communication with policyholders.
We handle claims appeals, ensuring a thorough review of denied claims and resolving issues to maximize claim approvals.
We ensure accurate generation and delivery of EOBs to policyholders, clearly outlining benefits, claim status, and any out-of-pocket costs.
Regulatory Compliance
Our regulatory compliance services ensure health insurers adhere to industry regulations like HIPAA and maintain accurate records.
HIPAA Compliance
We ensure all processes comply with HIPAA regulations, safeguarding patient information and ensuring confidentiality.
Audit Support
We assist in preparing for and conducting audits, ensuring all documentation and processes meet regulatory standards.
Data Analytics
We provide comprehensive data analysis services, ensuring accurate and compliant data management for audits and reporting.
Reporting and Analytics
Our team delivers accurate and timely reporting, helping insurers comply with regulatory requirements and make data-driven decisions.
