Claims Administration Services

Overview	Billing Provider Solutions	Provider Solutions	Payer Solutions	Technology Solutions	Benefits Administration
Overview \| Claims Management & Admin Solutions \| Cost Avoidance & Audit Solutions \| Customer Care Solutions

Increased Quality at Lower Price Point
With escalating cost of healthcare and demand for new and innovative products, administrative efficiencies have become imperative for healthcare payers. The focus is on creating savings to offset cost of care and create a pool of funds for future growth.

Our Claims Administration Services have a track record of doing just that with a range of services using HIPAA - compliant processes within our state-of-the art service centers. We enable you to increase your claims administration efficiency while decreasing your costs and stabilizing your claims operation.

We provide tangible results by combining our extensive domain knowledge, business rule engines, and world class operating model.

Our services include

•Enrollment & Demography Change management •Member Validation Upload into CMS system •PCP Change management •Eligibility Verification , Member Status •ID Card, Drug Card & TA facilitation	•Data capture •Claim Information Capture •Claim Data Audit, Member Validation •Adjudication •Benefit & Fee Schedule validation •EOB & Check updates	•Authorization & Referral capture •Critical Incidences Recording •MIS for UM •Member & Provider Reports •Daily Inpatient Census & case management report
Member Management	Claims processing	Utilization & Report management



•Provider Enrollment & Data Modification •Credentialing •Rate Fee exception	•Contract Negotiation Support •Receipt, Record & Analysis of appeals •Amount payable for favorable cases •Process for payment •Refund Posting	•Plan benefit Configuration •Provider Additions •Provider Contract Uploading •Fee schedule Maintenance •Rule upload & validation
Provider management (Non Network)	Grievance, Appeals & Refund	Configuration

Why e4e

Over 12 years of Claims processing Experience
Multi-plan, Multi-lines of business (HMO, PPO, MSO)
Technology Agnostic. The team has experience of working on 8 of the popular claims processing platforms in the market
An In-house proprietary claims processing platform that can be private labeled
Full service including technology & claims processing software since 2002
OCR & EDI solutions including ability to support 5010 transition

What you gain

Better and more cost-efficient handling of fluctuating transaction volumes
Reduced claims backlogs
Better accuracy in payments
Reduced training expenses
Better operational equilibrium so you can stay ahead of your competition
Reduce go-to-market time for new products

Healthcare Services

Overview

Billing Provider Solutions

Provider Solutions

Payer Solutions

Technology Solutions

Benefits Administration


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Payer Solutions

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