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HEALTHCARE PROCESS MANAGEMENT

Business Transformation Through Digitalization And Automation

TRANSFORMATION THROUGH DIGITIZATION & AUTOMATION

Improving health claims processes has a significant impact on the business of insurers. Efficient claims management helps insurers improve customer experience, reduce processing costs & time, adjudication errors, and increase regulatory compliance.

Datamatics Business Process Management (BPM) solution for healthcare helps insurers and payers transform their claims management processes. Its insurance clients have reaped significant benefits in terms of cost, speed, and accuracy by using TruBot, an enterprise grade multi-skilled robotic process automation (RPA) bot. Datamatics uses advanced imaging technologies, document capture, proprietary intelligent document processing solution, TruCap+, and rule-based algorithms to mine context and intelligence from unstructured data. This helps insurers minimize adjudication errors, reduce claims processing costs, increase efficiency, and deliver a superior customer service experience.

Datamatics BPM solution for healthcare enables enterprises to take full control and cognizance of monitoring and eliminating fraud in the claims processing. It engages Artificial Intelligence (AI) / Machine Learning (ML) algorithms and reduces instances of false positives and false negatives while improving the processing time and turnaround time.

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ADVANTAGES

30+

Years of Experience

Expertise in delivering intelligent solutions for the healthcare and insurance enterprises in both international and domestic markets

25 Million

Claims Processed Annually

Delivered automation projects using point solutions as well as end to end automation models across geographical barriers

100 Million

Images Processed Annually

Precision deliveries to ensure statutory compliance in a timely manner

Audit trails with high visibility and traceability


HEALTHCARE PROCESS MANAGEMENT OFFERINGS

PAYER SERVICES

Mailroom & Scanning - Healthcare Process Management Payer Services

Mailroom & Scanning

Engages intelligent document processing and RPA to expedite scanning and processing of paper-based forms

Provides exceptional processing speed and accuracy catering to all payer requirements

Claims Management - Healthcare Process Management Payer Services

Claims Management

Offers claims registration, claims verification, claims settlement & disbursement, fraudulent claims management and audit of claims management

Accelerates claim settlement procedures

Claims Pre-Adjudication - Healthcare Process Management Payer Services

Claims Pre-Adjudication

Adjudicate claims forms with minimal errors. and high levels of accuracy

Reduce instances of false positives and false negatives with AI / ML algorithms

Adjudication Services - Healthcare Process Management Payer Services

Adjudication Services

Facilitates faster settlements and lowers healthcare costs per claim

Ensures cost reductions in data processing and ensured savings year on year

Payment Processing - Healthcare Process Management Payer Services

Member and Provider Matching

Ensures accuracy in payments processing

Facilitates direct payment to account

Sales & Underwriting - Healthcare Process Management Payer Services

Sales & Underwriting

Offers effective contract management, sales automation, quote and rate underwriting, risk classification, and pricing solutions

E-Portal - Healthcare Process Management Payer Services

E-Portal

Offers interactive web portals to enhance member-provider engagement and interaction

Offers a digital ecosystem to expedite claim processing and settlement

Membership Management And Billing - Healthcare Process Management Payer Services

Membership Management and Billing

Ensures complete automation of the data management system to facilitate new membership enrollment, renewals, eligibility checks, monitoring, and client billing

Care Management - Healthcare Process Management Payer Services

Care Management

Presents user friendly, Omni-channel care management that helps payers provide on-demand support to patients

PROVIDER SERVICES

Revenue Cycle Management - Healthcare Process Management Provider Services

Revenue Cycle Management Services

Facilitates a seamless transition from the traditional ‘‘Fee for Service (FSS)’ payment model to a more integrated ‘Pay for Performance’ model, with automated coding and insurance verification

Payment Posting - Healthcare Process Management Provider Services

Payment Posting Services

Covers posting of payments received from Health insurance payers / members towards settlement of claims to relevant patient accounts

CRM SERVICES

Customer Information - Healthcare Process Management CRM Services

Customer Information

Maintains updated records of patient information and related contact details

Facilitates updating of interactions in the patient, payer, and provider ecosystem

IVR Solutions - Healthcare Process Management CRM Services

IVR Solutions

Offers all patient communication on a single platform; automates the hospital's precision care workflows and guides the patient with real-time data access.

Enterprise - Healthcare Process Management CRM Services

Enterprise 

Provides services and software for quality management, regulatory compliance, and F&A management

Offers auditable and enterprise grade solutions

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