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Services > Solutions for Healthcare
Payers
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e4e healthcare services assists Health Plans and Third Party Administrators in cost
reduction, quality improvement, and increased scalability through a full range of
outsourcing services, using a follow-the-sun approach. Our healthcare payer services
address the critical functions essential for the optimal operation of a health plan.
A health plan may be an insurance company, HMO, PPO, or an At-Risk Provider.
- Mail Room – Establish a true Digital Mail Room
- Image capture, OCR, indexing and workflow
- Data Capture and Validation
- Clearinghouse Services
- Validation of member and providers information
- 837, 270/271 etc.
- Member & Provider Data Management
- Member Status and Member Reports
- Eligibility management
- Medicare eligibility reconcilement
- Provider file maintenance
- Credentialing
- Member management and enrolment
- CMS interface and reporting
- Provider contracts
- Pend Resolution
- High-end resolution of pended claims
- Reprocessing/Adjusting completed claims
- HCC/RAF coding support
- EDI Services
- EOB printing & mailing
- 835 outgoing transmission
- Support for UM (Utilization Management)
- US Based Call Center
- Customer Service
- Appeals and Grievances
- Prospective Members information
- Seminar Information Sharing and Reservations
- DRG upcoding audit
- Identify practices with more than usual level of
E& M codes
- Procedures mismatch between professional and hospital
claims
- Highlighting provider enrollment errors
- Scrutinizing claims involving outlier payment
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- Proven experience in all Health Plan operations and functional areas
- Software skills to develop interface with any third party systems
- State of the Art fully-integrated processing platform and technology
- Cost based on a per transaction or per member/subscriber basis
- End to End solutions – Provider to Payer and back to Provider
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