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Health Claims Processing
Datamatics offers a wide range of services covering Claims Payment Processing, Sales & Underwriting, Membership Management Billing, Care Management, and e-portals.
Datamatics’ processes leverage TruBot, an Artificial Intelligence based Robotics platform that has been incorporated on large scale client engagement.
Claims Payment Processing:
- Over 3 decades of experience
- Process over 25 mn claims and 100 mn images annually.
1. Mailroom & Scanning: Exceptional processing speed and accuracy; catering to all payer requirements.
2. Claims Management: Claims registration, claims verification, claims settlement & disbursement, fraudulent claims management, audit, etc.
3. Claims Pre-adjudication: Adjudicate claims forms with minimal errors.
4. Adjudication Services: For faster settlements and lower healthcare costs per claim.
5. Member / Provider matching: For accuracy in payments processing.
6. Sales & Underwriting: Effective contract management, sales automation, quote / rate underwriting, risk classification, and pricing solutions.
7. Membership Management / Billing: Complete automation of the data management system to facilitate new membership enrollment, renewals, eligibility checks, monitoring, and client billing.
8. Care Management: User friendly, omni-channel care management that helps payers provide on-demand support to patients.
9. E-Portal: The tools and interactive web portals enhance member-provider engagement and interaction.
10. Business Intelligence & Data Warehousing: A comprehensive analytics suite facilitating provider management, fraud analytics, predictive modeling, enterprise data management, and HEDIS reporting.
1. Revenue Cycle Management Services: Transition from the traditional FFS (fee for service) payment model to a more integrated ‘pay for performance’ model, with automated coding and insurance verification.
2. Payment Posting Services: Enrollment Process, Payer Database, Member Database & Credential Verification.
Datamatics verifies the eligibility of the insurance holder through multiple modes including through a tool, IVR as well as through a customer care representative.
3. CRM Services
a) IVR Solutions: Offer all patient communication on a single platform. Automate the hospital's precision care workflows and guide the patient through real-time data access.
b) CRM Solutions: Maintain updated records of patient information and related contact details.
c) Enterprise: From services to software, Datamatics offers complete support to providers including quality management, regulatory compliance, and F&A management.