Modernizing the Payer Back Office with Artificial Intelligence

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Claims Administration

Leveraging the power of artificial intelligence to create breakthrough improvements in pre and post claims payment. 

Manual Touch Reduction

  • Insightful data patterns
  • Improve team allocation
  • Robotic Process Automation eliminates data silos

Claims Audit

  • Evaluates 100% of processed claims
  • Predictive algorithms flag claims based on error propensity
  • Improvement in Quality Scores

%

Reduction in manually adjudicated claims

Times lift in revenue leakage identification

Membership Management

Providing an artificial intelligence driven back office to help Payer organizations efficiently manage their operations. We specialize in helping our Payer clients with member satisfaction and retention.

Features

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Enrollment and Extraction

Machine learning enrollment and medical record extraction

Pricing

Flexible pricing model with PMPM and outcome based pricing

Adjustments and Coding

Risk adjustment and hierarchical condition category (HCC) coding

Benefits

Financial

Higher STAR ratings and additional reimbursements

Efficient

Maximum member enrollment

Quality

Increased member satisfaction and accuracy of 99% or more

Provider Data Management

Delivering measurable cost reductions and benefits.

  • Credentialing services
  • Provider contracting
  • Fee schedule maintenance
  • Provider update and changes
  • Provider data robotic automation

Features

Extraction

Electronic abstraction and validation

Validation

Routine provider data validation

Management and Credentialing

Adhoc provider data management and credentialing services

Benefits

Financial

Measurable cost reductions and benefits

Efficient

Improved process tracking and reporting

Quality

99% accuracy or more

Network Management

Scalable solutions that help store and manage large volumes of provider information. We support provider contracting and credentialing, out-of-network claims negotiation support, and fee schedule maintenance.

Features

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Validation

Electronic abstraction and validation

Routine provider data validation

Maintenance

Contract maintenance

Management and Credentialing

Adhoc provider data management and credentialing services

Benefits

Financial

Measurable cost reductions and benefits

Efficient

50% of productivity movement

Improved process tracking and reporting

Quality

Enhanced quality – 99% and above
Learn About Our Risk Free Proof of Concept

Learn about Our Risk Free Proof of Concept