Care/Disease Management

Care/Disease Management

Care management intends to reduce unnecessary health care costs through a variety of mechanisms that include assessment, planning, facilitation, care coordination, evaluation. This presents multiple options and services to exactly meet a person’s and families’ health needs with high quality cost effective outcomes.

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Claims Management/Adjudication

Claims Management

Claims Management for Healthcare Payers solutions generally aimed at achieving complete automation of claims processing, faster access to customer information without compromising on the security of private medical information. Automation helps in reducing costs associated with processing claims, utilize a single platform for all data sources, workflows for routing claims for review and approval, and increase the accuracy and timeliness of payments.

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Cost Management

Cost Management

Cost management is a planned approach that combines the skills of physician logic and automated claims surveillance with strategic financial intervention to improve outcomes of both quality care and rational costs. A critical evaluation of health care costs is an important component. Cost Management includes Claims Code Editing, Re-pricing, Negotiations and PPO discounts.

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EDI Modernization

EDI Modernization

Healthcare organizations are being challenged to provide quality services and comply with regulatory requirements without losing eye on keeping costs in check. Integration between payers and providers is crucial in achieving this and this has traditionally been done using expensive EDI solutions and proprietary VANs (value added networks) for exchanging claims, enrolment, eligibility, and payment advice information.

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Health Insurance Exchange/Marketplaces (HIX)

Health Insurance Exchange / Marketplaces (HIX)

To facilitate coverage expansion, the ACA establishes health insurance exchanges, or marketplaces, which allow individuals to choose among competitive plans. With the open enrolment in insurance products offered through the federal and state health marketplaces begins, individuals gain more control over how they spend their healthcare dollars. These new marketplaces will allow individuals with low to moderate income to purchase insurance eligible for government subsidies.

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ICD-10 Compliance (Remediation)

ICD-10 COMPLIANCE (REMEDIATION)

Healthcare organizations are being challenged to provide quality services and comply with regulatory requirements without losing eye on keeping costs in check. Integration between payers and providers is crucial in achieving this and this has traditionally been done using expensive EDI solutions and proprietary VANs (value added networks) for exchanging claims, enrolment, eligibility, and payment advice information.

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Predictive Analytics

Predictive Analytics

Predictive analytics comprise of a variety of statistical techniques from modelling, machine learning, and data mining that analyse current and historical facts to make predictions about future events. When large amounts of historical transactional data is available, mining this data leads to finding interesting patterns, which can be exploited by predictive models to identify risks and opportunities.

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