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BPM
- Overview
- Services
- Why Technosoft
- We Can Help
- Showcase
The Healthcare Payer industry is facing challenges such as reform-related regulatory changes and the shift to a more consumer-centric approach. The need of the hour is to reduce the cost of healthcare, while managing high risk profiles, and inducing preventive solutions to maintain population health.
Our Payer healthcare segment solutions enable commercial, Blue plans, and Healthcare exchanges to improve patient outcomes through better care co-ordination, collaboration and management – while making sustainable performance improvements that drive financial health. Through our expertise, we help health plans drive better health outcomes, provide connected care, monitor population health, undertake risk management, and use healthcare analytics and demand forecasting to provide care in a rapidly-evolving industry.
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Claims Administration |
Claims Administration:
We provide solutions for claims re-pricing and 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.
Services include:
Claims Data Entry
Pre-Adjudication
Claims Adjudication
International, RX & CDH claims processing
Claims Re-pricing
Claims Adjustments
Determine coverage eligibility
Adjustments and appeals
Claims Audit
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Provider Management |
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
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Policy Administration |
Policy Administration
Enrollments - New Enrollments & updates maintenance
Eligibility Management
Pre-Ex & COB information and verification
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Network Management |
Network Management
Out-of-Network Claims Negotiation Support
Provider Contracting
Contract Maintenance
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Membership Management |
Membership Management:
Our services help you stay flexible in a changing environment and efficiently manage your back-office with member satisfaction & retention.
Enrollment & Eligibility verification.
Membership changes & updates.
Renewal and premium billing
Customer service.
Medicare advantage enrollment process – AEP & Non-AEP process, TRR codes & eligibility validation.
Risk Adjustment and Hierarchical Condition Category (HCC) coding
Premium Billing and Reconciliation : 27
HCC Coding
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Clinical Services & Reporting |
Clinical Services & Reporting:
Technosoft clinical services include:
Risk Adjustment and Hierarchical Condition Category (HCC) coding
HEDIS reporting
Code Audit & Compliance.
ICD-10 services.
Over Payment & Recovery services.
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Analytics |
Analytics
Technosoft provides a wide range of solutions to enable better clinical decision-making, improve member care, manage risk and drive better market access. Our data scientists and analytics experts enable next-generation care management decision support, patient-centered and consumer-centric health models, and actionable insightssuch as identifying claim overpayments, to drive higher efficiencies and cost containment..
Payer Analytics Solutions
Our payer analytics provides the insights you need to negotiate fair and accurate rates with providers. Our actionable insights help improve productivity, giving care managers the ability to engage with more members than ever before. By assisting members in avoiding hospital readmissions, choosing appropriate care settings, and managing their own health conditions, care managers can reduce utilization costs across the board
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Mobility |
Mobility
Enterprise mobility solutions are becoming a strategic priority for CIOs to further increase and heighten their business execution. In coming years the shift to a mobile-centric model is all set to accelerate. With the already installed base of smart phones and tablets we are now in the early stages of a dramatic shift in the user experience. This rapid adoption of mobile technologies is driving organizations to enhance device and service management capabilities.
Being leaders in mobility solutions, with strong offerings, integrated workflows and simple user interface, we help healthcare providers optimize and streamline the way data is entered, accessed, and shared, resulting in improved delivery of care. Our payer solutions are deployed including wellness ERP, IVR, Claims reporting areas.
- Ability to deliver across the process value chain – providing high complexity support on Actuarial, Disease management, risk profiling, claims fraud detection, investigation.
- At 95% accuracy, our adjudicators process medium to high value claims with service levels ranging from 24-48 hours
- 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
- Proprietary knowledge management and workflow tools with value-added services
- High standards of people processes, domain knowledge, business process improvement and compliance
Technosoft is committed to offering value-added Healthcare BPM + 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.This helps provide improved care, faster access, lower costs and enhanced bottom lines.
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 offerings are tailored to mitigate specific customer pain points, and also provide comprehensive, sustainable, scalable solutions. We have large pool of skilled resources who can be deployed in no time to kick-start new engagements, both at our onsite and offshore centers.
Key differentiators are:
- Vertical Domain-specific skills
- Organization with strong leadership and a clear vision
- Senior leaders to oversee 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 and practices
- End-to-end Management
Pumping in adrenaline booster to Michigan's largest health insurer helps deliver happiness to the users of their membership portal.
The client’s customer management portal had over 5 million users on board, allowing members to retrieve their policies and claims, and other connected health insurance details. It also displayed member-specific data such as the total claims and transactions over a given period. The client needed a partner to help improve their portal’s performance, as it was declining with time. The requirement was to make the portal an efficient, customer-friendly and safe self-service tool for members. Technosoft helped the client by resolving functional issues while conducting performance testing in the quality assurance environment. Our engagement team also made proactive suggestions for overall application enhancements, such as smarter ways of pulling data from an existing system to reduce time lag, uncovering security issues and resolving them.
A leading health insurance provider discovers the competitive advantage of its Interactive Voice Response (IVR) system.
Technosoft’s 4 stage approach in Membership Management boosts self-service and contained rates for the insurance provider. With a systematic, user-centric approach to analysis and design of the IVR functionality, we were able to increase the rate of callers with higher containment rates. We were also able to reduce the average call duration by up to 50%, thereby increasing cutomer satisfaction.