Like most payers, you are probably challenged by the rising costs of healthcare, increased adoption of technology and prevalence of quality and performance based reimbursement models. These changes have also caused the dynamics of the physician-hospital-patient to shift as well. By leveraging healthcare Business Process Outsourcing (BPO), you can redefine your operating model and maximize value from your business processes. Many payers are increasingly using BPO to control costs, improve administrative efficiencies and optimize Medical Loss Ratio (MLR). With our singular focus and extensive healthcare industry experience, emids understands information exchange, the impact of regulatory reform and process flow as well as the challenges. We use our experience to provide proper assessment and planning so that you can get the highest productivity from your business.
Payer Business Services Portfolio
More specifically, emids Payer services portfolio can help payers and Health plans operate more efficiently by reducing the cost of front, middle, and back-office processes. Since accuracy and efficiency are essential, we can also help you with the configuration of functional business requirements and the rules necessary for claims and legacy applications to run efficiently. This includes meeting claims processing standards and auto-adjudication targets. We provide support on accountable care and chronic care management assistance, data aggregation, health information exchange, data security, analytics, new plan design, claims modernization, utilization management, fraud waste or abuse, data mining and case management services.Our business services include:
- Provider network configuration-timeliness and speed in onboarding providers
- Claims administration services – from Workflow to Workforce, emids guarantees increase auto-adjudication and first-pass rates and reduce claims rework and turnaround time.
- Enrollment Management – from Marketplace management to timeliness and accuracy in enrollment.