Business Process Outsourcing

Like most healthcare businesses, 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, which affects your customers. By leveraging healthcare Business Process Outsourcing (BPO), you can redefine your operating model and maximize value from your business processes. Many infomediaries are increasingly using healthcare business process outsourcing 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 healthcare process outsourcing. Our BPO services include:

  • Identifying gaps in business processes leading to returns to your business partners which includes annual cost savings, streamlined and updated processes and an increase in processing productivity, greater accuracy and faster turnaround for customer service
  • Providing flexible, on-demand access to specialized resources
  • Helping payers and providers in the key areas of cost and quality, implementation, security and compliance, infrastructure and application management and support models

Infomediary Services Portfolio emids provides healthcare process outsourcing services such as application development, maintenance, support, data management and EDI interface development as well as BPO services for supporting pre-authorization processes of the specialty benefits management companies. We provide the following healthcare business process outsourcing services:

  • Web Portal & Decision Support Portals QA & Testing support
  • Automated Authorization Review System
  • HIPAA Transition Services

Utilization Management Services

  • Radiology
  • Cardiology
  • Oncology
  • Lab
  • Others –Drugs/Pain/Sleep management

Health Plans & Clearing House services/Claims Adjudication/Contract Management

  • FTP-837p,834,278,835
  • Scheduler
  • Data Transformation
  • EDI Mapper

Business Process Operations

  • Prior Authorization intake-Fax/Phone/Web portal
  • Medical Management
  • Claims Processing
  • Preauthorization Request review & Clinical Reading
  • Procedure Review, Diagnosis Review, Demographic & Eligibility Analysis, provider review
  • Case Creation, Update and Routing
  • Authorization Extract
  • Status Reporting

Ready to get started?
Contact us today!