Economic pressures on healthcare organizations continue unabated. Decreased enrollments, rising costs and increased competition are forcing Payers to reduce operational costs to remain competitive and viable.
SOURCECORP can help with rapidly deployed services that reduce cost, improve performance and maximize enterprise productivity. We possess industry–specific expertise to manage the complexities for full lifecycle claims processing and information administration.
Through our closed loop service offerings we can support all aspects of your business needs including:
- Claims Processing and Adjudication
- Reimbursement Analytics and Medical Cost Containment
- Membership Enrollment
- Regulatory Compliance Administration
- PHI Security Breach Administration
- Coordination of Benefits / RxCOB for Part D and Medicare Advantage
- HIPAA Notifications
- Return Mail / Address Verification Services
- Survey Administration
- Fulfillment and Disbursement Services
SOURCECORP Offers Clients
- 10 to 12% increase in auto–adjudication rates
- Reduced annual operating budgets
- Reduced member application turnaround times under 24 hours
- Streamlined individual medical applications for one client from 1,500 to 120 forms
- Average savings of $4,500 per institutional inpatient claim with payment analytics
SOURCECORP End-to-End, Closed Loop Services
- Claims processing and adjudication programs for both paper and EDI
- Rapid enrollment programs to facilitate online, paper forms, fax and inbound / outbound call centers
- Unique payment analytics to detect, substantiate, defend and recover Provider overpayments based on contracted fee schedules and coding logic
- Coordination of Benefits [RxCOB] for mandated government compliance and determination of other secondary liability
- Back–end disbursement and fulfillment programs including checks, EOBs, premium bills, commission statements and notices
Case Studies
- Fortune 100 Client Optimized claims processing improves turnaround times and quality levels.
- Phased business solutions and state–of–the–art workflow programs improve data accuracy, streamline systems and reduce internal costs.