Healthcare

Healthcare plans are under continual pressure to reduce costs, streamline processes, address consumer demands, and create new products and wellness solutions. And it must be done without sacrificing quality of care to members or placing additional burdens on providers.

Count on us to create administrative efficiencies through our transactional business solutions. We can also deliver cost-of-care efficiencies through our cost recovery and cost avoidance services. For you, it means a more engaged consumer, via our innovative contact services and call center solutions.

Transactional
Services
Healthcare costs keep rising. But so does the demand for new and innovative products. How do you improve quality while reducing costs? How do you offset the rising cost of care while funding future investments?

Let us help you create solutions to increase data quality, improve turnaround time and boost your bottom line. We’ll provide your health plan with results in solution areas that include:

• EDI Clearinghouse
• Mailroom
• Data Capture/OCR
• Claims Processing
• Membership Enrollment/Eligibility
• Billing, Payment and Reconciliation

Contact Services/Customer Care

Are you looking to engage stakeholders in new and innovative ways? It requires customer care engagement models with market understanding and clinical and consultative expertise.

Our contact centers bring all these disciplines together within one organization. Our solution areas include:

• Member and Provider Inbound
• Self-Service Contact
• Web, Chat and E-mail Response
• IVR and CTI-Based
• Advanced Switch/Multiple Platform Integration
• Customer Relationship Management (CRM)
• Workforce Management.

Cost Recovery, Audit and Avoidance
Enable administrative efficiencies. Engage your stakeholders. How do you do both while managing cost of care?

Let us help you on the path from cost recovery to cost avoidance. We offer end-to-end services to help you avoid and ultimately recover claim costs. Our service areas include:

• Data Mining and Analysis
• Subrogation
• Coordination of Benefit
• Overpayment Solutions
• Hospital Credit Balance Audits
• End-Stage Renal Dialysis Analysis and Audits
• Long-Term Care Analysis and Audits
• Pharmacy Benefit Management Analysis and Audits

Today’s healthcare environment, challenges providers with:

• Rising costs
• Lower reimbursements
• Staffing shortages
• Regulatory deadlines
• Threats to quality of care
• Administrative inefficiencies

That’s where we come in. We have deep knowledge of healthcare’s:

• IT needs
• Clinical workflows and processes
• Administration and patient accounting
• Business office and revenue cycle operations.

We have expertise in all of the industry's leading software products and are the #1 ranked CIS Implementation Partner by KLAS Research. So you can count on us for reliable, hands-on assistance and consultative advisory services.

Our service areas include:

• Financial and Clinical Applications Consulting and Hosting
• EHR/ARRA Solutions
• Regulatory Compliance Solutions (JCAHO, 5010, ICD-10)
• Transformational Outsourcing
• Revenue Cycle Solutions

Consulting Services

Today’s end users of clinical technology are experienced and self-reliant – often using multiple vendors’ products on their own. So, we’re often called in for consulting services in project management, operations improvement, backfill services, staff augmentation and clinical lead experience.

We’ve implemented all major healthcare software platforms. Benefit from our multi-faceted approach, and you can:

• Improve quality
• Reduce operating costs
• Increase staff productivity
• Improve patient/physician/staff satisfaction
• Continuously track accreditation readiness.

Transformational Outsourcing

Rising healthcare costs and revenue limitations from payers. How do you reconcile the two? More and more, providers are relying on digital information and communication – which may exceed their internal financing capabilities.

Give us a call. We have the knowledge and expertise to help you implement and manage a full range of technology services and solutions, including:

• Interim IT Organizational Management
• Infrastructure Technology Outsourcing
• Application Management and Hosting
• 24/7 Remote Network Monitoring
• Help Desk and Desktop Support.

Revenue Cycle Solutions

Billing and collection cycles are costly, fragmented and labor-intensive. Disjointed information systems are redundant, and manual processes are inconsistent. The result is inefficient cash management.

We offer a full array of services to improve financial performance. They’re gleaned from more than 60 years of revenue cycle management knowledge and experience. Let us enhance your processes with enabling tools and training. They can help you achieve and sustain significant revenue cycle performance and cash improvements.

Our service areas include:

• Revenue Cycle Performance Evaluation and Inprovement
• Denial Management
• A/R Collections Recovery
• Business Process Redesign
• Information Technology Planning, Selection and Implementation
• Revenue Cycle Outsourcing

Analytic Solutions
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Our Analytic Solutions group is a market leader in medical information management technology. Its MIDAS+ software suite enhances care management, clinical decision support and provider information management functions.

The MIDAS+ solutions suite includes:

• MIDAS+ Care Management – integrates discipline-specific modules in the Case, Quality and Rick Management subsystems
• MIDAS+ SmartConnect – automates discharge placement workflow and electronically connects all constituents in the care continuum
• MIDAS+ DataVision – a suite of data analysis and benchmarking tools comparing over 3,000 performance measures in the MIDAS+ national comparative database
• MIDAS+ Seeker – a comprehensive medical staff management solution that includes online appointment/privileging and Web querying
• MIDAS+ BedReady – a full-featured capacity management and patient throughput solution for bed management, housekeeping and transport

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