Operational Efficiency for Health Plans

Improving your health plan's operational efficiency is a business imperative as regulatory bodies and consumer groups increase oversight of how health plans spend their money and new value-based reimbursement models challenge your pay-for-performance expertise. Our suite of network and financial management solutions empowers your health plan to operate as efficiently as possible and drop every compliant dollar to your bottom line.

Our flexible network contracting solutions expedite your health plan's provider contracting process and reduce your administrative costs by creating a single, electronic repository of contract information, coupled with collaborative workflow tools for automating and streamlining the entire contract management lifecycle. Our advanced and scalable claims management solution integrates with your existing claims processing system to help ensure adherence to coverage, reimbursement and benefit policies, as well as new industry-standard coding practices like ICD-10. Our Managed Care Optimizer™'s hosted application combined with fully outsourced medical claims processing provides the same functionality as an on-premise processing center, with the added benefit of a predictable monthly expense. We also can infuse your claims processing system with a predictive analytics capability to identify problematic claims before you pay them, reducing your administrative costs of paying and then chasing improperly billed and paid claims. Our auto-authorization solutions help streamline the payment process and save repetitive processing by building transparency with providers before services are provided.

Today's increasingly complex health insurance market challenges your health plan's ability to operate as efficiently as possible. Our unique suite of network and financial management solutions can help your health plan automate and transform complex financial processes and simplify reimbursement and network management, greatly reducing your administrative costs.