Health Claims Processing

Overview

Payer Services

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.

 

Our Services

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.

Provider Services

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.