 Enrolling providers into a payer's network is an important function in the healthcare delivery model. It establishes the required data sets necessary for payers to serve members and pay claims. Typically, this process is the first encounter between a provider and payer and can set the tone for future interactions. Highly manual and laborious, the provider enrollment process is fragmented across different business units. For example, separate enrollment actions are required to provide services, engage in electronic data interchange and receive electronic payment. Furthermore, the process is paper based and error-prone, resulting in inefficient process flows. Based on the principles of transparency and collaboration, our solution automates the provider enrollment process and facilitates data management. Among the service's key benefits are increased cost savings and efficiencies, improved data accuracy and the reduction of fraudulent claims payments. Our solution also allows state provider management units to launch new initiatives, including new credentialing requirements and provider types.
We provide a single point of entry, via the Web, for providers and your staff. Reduce your call center burden with our provider self-service capability that enables providers to research claims and payment status and update their demographics and other information.
We offer flexible data structures to adopt business and regulatory changes. Apart from these data structures, the system leverages user-configured checklists and business process steps to allow for the online enrollment process to accommodate a diverse provider community. National Provider Identifier (NPI) is supported to maintain and operate on NPI Identifiers for individual, facility and managed care organizations. Interoperability is not lost with our ability to support alternative identifiers of other agencies or divisions' provider applications.
See also:
Benefit Plans Design & Implementation
Claims Adjudication & Management
Member Management for Holistic Insight
Financial Integration
SOA Integration
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