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HEALTHCARE CLAIM SERVICES

 

In an increasingly competitive market, your company's survival depends on optimization and driving operational, technological and cost improvements. Long term success depends on thriving in a consumer focused environment. iSpace can help achieve both your short term and long term goals by delivering a powerful combination of business and information technology capabilities to create value for your end consumer.

iSpace was one of the first to apply lean manufacturing techniques to the benefit administration process that helped to bring about measurable and sustainable results oriented transformation to health plans. Through the combination of right people, process and technology, iSpace is committed to help clients transform from a fragmented model to a holistic system that supports consumer well-being and positive results.

Our services address the following critical processes essential for the operation of a health plan:

  • Enrollment :Member enrollment including submissions to CMS and Provider enrollment.
  • Eligibility:Online, offline and phone based eligibility support with real-time systems to streamline the process.
  • Mail Room Services:Complete in-bound & out-bound mailroom handling with online access to images and document management.
  • Front-End Claims Processing and Management:Capturing data from paper and electronic claims and managing duplicates, denials and other front-end edits.
  • Claims Adjudication:Manage the adjudication and resolution of all claims documents including error correction and issue resolution to meet Turnaround Time SLA's.
  • Premium Billing Services:Billing employer groups for employee coverage.
  • Customer & Member Service:Member and customer service via telephone, email or online.
  • PPO – Provider Database Cleansing:Managing the provider data to maintain up-to-date accurate demographic information. This includes call outs, mail outs and email campaigns.
  • PPO –Contract Management
  • PPO –Claims Repricing
  • PPO–Savings & Disruption Analysis
  • Credentialing
  • Overpayment Analysis & retrieval
  • Claim Audit, Reconciliation & Recoveries
  • Consumer Driven Health Plans Administration

PAYER PROCESSES

 

Enrollment

  • Imaging and Data Digitization
  • Indexing
  • Data Entry
  • Underwriting
  • Policy Generation

Policy Maintenance

  • Member Demographic Changes
  • Premium Administration
  • Policy Renewal
  • Policy Coverage Changes

Claims Administration

  • Claims Data Entry
  • Pre-Adjudication
  • Adjudication
  • Statement Processing

Customer Service

  • Claims Status Enquiry
  • Product Enquiry
  • Pre-Authorization
  • Premium Enquiry
  • Provider Network Enquiry

Collections

  • Over Payment Recoveries

BENEFITS FROM PAYER SERVICES:

Clients can realize measurable and sustainable results such as:

  • Improve patient satisfaction
  • Lower administrative and operations costs with improved efficiencies
  • Improve Turn Around Time of claims processing without compromising on accuracy
  • Free up valuable internal resources while we manage transactions
  • Enhance customer service levels and customer retention & acquisition rates
  • Lower costs for regulatory & HIPAA compliance
  • Turn fixed costs into variable costs

TECHNOLOGY:

As part of our service delivery, iSpace can bring the following technology & services to improve the Payer process:

  • Document Management System
  • Mailroom Services
  • E-Billing engine and service
  • E-Eligibility verification engine
  • Workflow automation system
  • Adjudication platforms through existing partners
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