Pre-Adjudication
The claim pre-adjudication process consists of entering data that verifies member and provider information, which logically organizes the information for future use, then sends it to a core system for processing. Thoroughness at this level results in increasing first pass adjudication rates and shorter processing intervals.
The pre-adjudication professionals at iSource Worldwide are highly experienced and have an in-depth knowledge of various policies, plans and healthcare providers. Our systematic process of pre-adjudication gives us greater control over claims, improved quality, shorter turn around time, and a dramatic reduction in operational and IT expenses. We ensure complete accountability of data to our customers and a comprehensive reporting structure.
Post-Adjudication
With a dedicated project manager to navigate a full spectrum of global billing practices, our follow-up capabilities help payers avoid inaccurate reimbursement. iSource Worldwide works with clients to provide high quality SLA-driven claims, customer support and adjudication services.
Our healthcare adjudicators are trained on multiple plan designs and platforms, as well as relevant medical terminologies. With our combined expertise and analytical capabilities, we can ensure complete accountability of the data. Our systematic, high standard output, saves healthcare payers a significant percentage of adjudication costs.
Our claims adjudicators immerse in client specific training for insurance plans, systems and claim types. We work to create a detailed project plan, verifying the requirements that determine the critical success factors we are striving to meet. In addition, we develop a comprehensive communication plan to define the communication channels and to review status, issues and amendments to plans. Again, a project manager manages the entire process.
Contracts Management
One of the major challenges confronting the healthcare industry is the ever changing complex healthcare payer contracts. Healthcare payers need to frequently evaluate and modify the plans they offer as well as actively manage the provisions of their agreements with the various parties. At iSource Worldwide we have an ongoing data entry and maintenance program that continuously tracks the contracts, resulting in significant cost savings for healthcare payers. We also support the customers through our periodic reporting system and also through inbound and outbound call center.
Claims Fraud Analysis
With annual loss increases being incurred by the healthcare insurance industries because of fraud, it becomes extremely important to identify those fraud and abuse problem areas. At iSource Worldwide, our Claims Fraud Analysis is designed to scrutinize the entire billing lifecycle. Our process evaluates the payer, provider, and patient, and includes the investigation, evaluation, negotiation and settlement of billing claims.
Call us at 888-947-6872 to talk about the services iSource Worldwide can deliver for your business success.
To find out more about how iSource Worldwide is ready to assist the healthcare industry, click on a link below.
>> Answering Services
>> IT, Software
>> Medical Content Development
>> Medical Coding & Transcription
>> Data Management
>> Call Center Support
>> Payer Services
>> Provider Services
