Payer Services

BPM

  • Overview
  • Services
  • Why Technosoft
  • We Can Help
  • Showcase

Technosoft is a nation market leader for global provider of healthcare services to Payers, Accountable Care Organization, Benefit Management & Wellness services, Hospitals, Integrated Health Networks, Large Physician groups, & Long Term Care Pharmacies. For more than a decade, Technosoft has developed a strong legacy and a proven track record of providing healthcare services to both US Providers and Payers. Technosoft is certified for ISO/IEC9001:2008 for Quality Management System and ISO/IEC27001:2005 for Information Security Management System. With the implementation of security controls, it has achieved the compliance for HIPAA, HITECH and other laws and regulations. Technosoft is poised for CMMI Level 3 Assessment in next couple of months.

The specialized talents of our people reflect our passion. We employ over 3,000 staff globally with offices in the US, India (Chennai, Bangalore, Hyderabad & Pune) who advise, support and perform the core business operations for large Payers & Provider organizations.

Our solutions, industry experts and data-driven methodologies are helping healthcare enterprises make informed changes to drive total cost reduction, delivery alignment, drive efficiency, financial optimization and Revenue acceleration for Govt programs. We have the capability of delivering compelling business value to our clients, right shoring between our geographical sites and our best practices.

Our services are tailored to help our clients choose a delivery model that best suits their unique business requirements. We are committed to working with other companies in order to offer clients interoperable solutions and greater access to innovation.

Claims Administration: 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.

  • Claims Data Entry
  • Determine coverage eligibility
  • Adjudication
  • Remittance advice
  • Adjustments and appeals
  • Claims Audit

Technosoft works as dedicated partner with the payer providing high quality SLA-driven claims customer support and adjudication service utilizing a mix of offshore and onshore staff.

Provider Management: Our provider management services steer measurable cost reductions and benefits through multiple aspects

  • Database management
  • Provider demographics
  • Validating contract documents
  • Pricing maintenance and configuration
  • Network eligibility
  • Contract mapping
  • Credentialing
  • Contracting services
  • Improved process tracking and reporting
  • Continuous updates, verification and record maintenance to ensure accurate and timely claims payments

Our healthcare payer analytics provide the insights for negotiating fair and accurate rates with providers, ensuring better care at fair prices.

Membership Management: Our services help you stay flexible in a changing environment and efficiently manage your back-office with member satisfaction & retention.

  • Enrolment & Eligibility verification.
  • Membership changes & updates.
  • Renewal and premium billing
  • Customer service.
  • Medicare advantage enrolment process – AEP & Non-AEP process, TRR codes & eligibility validation.
  • Risk Adjustment and Hierarchical Condition Category (HCC) coding

Clinical Services & Reporting: Our goal is to save you time and money as well as to accurately identify missed and at-risk revenue to boost your bottom line. Technosoft clinical services include:

  • Risk Adjustment and Hierarchical Condition Category (HCC) coding
  • HEDIS reporting
  • Code Audit & Compliance.
  • ICD-10 services.
  • Over Payment & Recovery services.

Benefit Management & Wellness Services: Our integrated business services help healthcare payers provide outstanding customer experiences, maximize operational efficiency, minimize their medical loss ratio & manage the high risk patient management.

  • Immunization services
  • Health risk assessment
  • Wellness services
  • Recruitment  - Provider profiling and database services
  • Case Management
  • Flu reminders
  • Brand  switch services
  • Medication reminder
  • Disease management support

Technosoft Payer Resource comes with over 8 years of experience in healthcare BPO, offering the ability to absorb new clients with a short learning curve. Our best-in-class technologies enable transparency in internal functions such as workflow, HR, communications, Quality and reports. Our client focused solutions offer the following business advantages:

  • Experienced management team with health insurance BPO services background in Fortune 500 companies
  • A delivery model that optimizes performance to provide demonstrable cost savings of 30-40%
  • ISO 9001 since 1999 & HIPAA Compliant
  • Nearly 3000+ associates across multiple locations
  • Dedicated 4 offshore location for healthcare
  • Processing over 100 million transactions every year in Healthcare
  • 5 M Number of  customer service call per annum including chat
  • Onsite transition, little time investment by current staff, future based business relationship.
  • We use LEAN and Six Sigma methodologies to simplify existing business processes by cutting down inefficiencies.
  • Highly evolved in key BPO functions such as transition management, account management, client experience and stakeholder satisfaction.
  • Client focus, long term partnerships, integrity and innovation to ensure longevity and sustainability of the organization
  • Stable and profitable organization with about 85% management retention for over a decade
  • Innovative best in class technologies for management and transparency across all functions
  • High standards of people processes, domain knowledge, business process improvement and compliance
  • At 99% accuracy, our adjudicators process medium to high value claims with service levels ranging from 24-48 hours
  • Ability to deliver across the process value chain – providing high complexity support on Actuarial, Disease management, risk profiling, claim fraud detection, investigation.

Technosoft is committed to offering value added Healthcare BPO + IT solutions to our clients for performance optimization and profitability. We have always aimed to be value partners to our clients, taking pride in their business growth. The company’s operational approach is designed to create strategic partnerships with clients and provide exceptional customer service.

We believe true value is best created when our solutions focus on specific client issues and are developed with intensive analysis and expertise. Our diverse bouquet of offerings not only deeply resonates with customer pain points but also provides comprehensive, sustainable, scalable solutions. We have large pool of skilled resources both at our onsite and offshore centers.  These skills can be deployed in no time to kick start new engagements. Some of our differentiators are:

  • Vertical Domain specific skills
  • Organization with Strong Leadership and a Clear Vision
  • Senior leaders to oversee to the success
  • Cost Effective Engagement models
  • Strong Focus on Business Transformation through Advanced Technology
  • Fully Integrated Technological Solutions
  • On-shore presence and availability for account management, subject matter expertise and sales assistance.
  • Best in Class People & Practices
  • End-to-end Management

Visit us soon.