| Claims Processing & Payments |
 |
|
Today, MphasiS seamlessly manages 57 million annual transactions for leading insurers, financial institutions and others. We help client improve their profitability as well as competitiveness through quality output.
|
| Our claims function business process offers the following solutions: |
| Integration of the legacy system with work flow management tools for better process handling and improved customer service |
| Automation of the claims processing system to bring about seamless connectivity of all personnel involved. (Call center, field representatives, claim adjusters, office claim representatives, salvage yards and towing agencies, etc.) |
| Sorting and assignment of work processes to the responsible center |
Web-enabling of claims processing so that services from submission of claims to queries on claim status could be achieved online
|
| High-level Claims Function Business Process |
|
|
| BPO services |
In the insurance world, our BPO capabilities span new business acquisitions, policy administration, policy underwriting, claims management, and customer service. In the area of claims processing, we provide services for the entire lifecycle including intimation, management, settlement, and recovery in Property & Casualty Insurance and Healthcare. We deliver our claims processing services using our proprietary claims handling platform which automates the entire lifecycle of claims and cuts down the processing cycle time and improves the accuracy of claims processes significantly.
We are a full-service provider in the Healthcare space with high-value added services, deep domain expertise, a proprietary claims handling and payments platform and a widening customer base. Our back office claims processing services cater to insurance companies, Third Party Administrators (TPAs), Health Maintenance Organizations (HMOs), Self-Funded Employers, Preferred Provider Organizations (PPOs) and Managed Care Organizations (MCOs).
|
|
More 
|
| IT services |
Our IT Services provide insurance companies with technology solutions that are tailor-made to their unique and complex business requirements. Our skills encompass the entire gamut of services from design, development and integration of applications to the operation of key processes.
|
We offer the following solutions :
|
| Tool/Product Implementation |
| Customer Relationship Management (CRM) products |
| Sales enablement products |
| Agency Management System |
| PDA-based Sales System |
| Financial calculators, insurance calculators, real-time quotation |
| New distribution channels |
| Call center, Web, PDA, etc |
| Workflow and document management products |
| Portal development tools |
| Personalization, profiling and content management tools |
Knowledge management systems
|
| Insurance Products |
| Product re-engineering |
| Rating engine, quotation, validation and testing engine |
| Automated underwriting and claims tools |
| Actuarial tools |
Insurance remittance processing
|
| Application Integration |
| Integration with agency systems/back end systems/payment gateways/partner sites |
Legacy system integration
|
| Application Life Cycle Management |
| Application development and maintenance outsourcing |
| Legacy extension & transformation |
| IT & Data Architecture |
| IT & Data architecture workshops |
| Security workshops |
Service Oriented Architecture workshops
|
More
|
| Platform-based Solutions |
Virtual Process Manager (VPM), our virtual-team based processing tool, enables modeling and execution of document centric business processes that require collaboration across people (workflows), systems (process automation and integration) and geographies (multiple/offshore locations).
|
| In insurance processing, VPM can be utilized to: |
| Reduce processing cycle times/costs |
| Improve tracking and reporting of process steps for end customers |
| Provide workflow based, web-enabled infrastructure to associates, claim handlers, etc |
Ensure information accuracy/completeness
|
MphasiS' healthcare platform, HEALTHpac, is a comprehensive health benefits management system. Designed as a fully integrated software product, HEALTHpac enables clients to achieve in excess of 70% auto-adjudication, thereby resulting in increased efficiency. Real-time workflow, along with online servicing and reporting, crystallize both transaction and data management.
|
| The product features include: |
| Enrollment & Billing Administration |
| Embedded, User-Defined Workflow |
| Comprehensive Call Management |
| Pricing/Re-pricing of Professional and Facility Claims |
| Automatic Claims Adjudication Logic |
| Integrated Case Management |
| Real-time, Web Servicing & Reporting |
| X-12 HIPAA Manager (EDI) |
| Flexible Benefit Design for All Business Lines |
Dental Logic
|
The benefits of HEALTHpac platform are:
|
| Accelerate your plan building processes |
| Experienced HEALTHpac professionals can accelerate and optimize your plan building processes to bring new groups on rapidly. This team can also assist with plan design consulting, monitoring your exception traffic in an effort to increase automation. |
| Code and field validation |
| Enrollment and claims data entry can make a dramatic difference in meeting your Service Level Agreements. Our rigorous quality assurance standards include code and field validation. |
| Proper routing of claims processing as per the business rules |
| Your specific business rules can readily be adapted using HEALTHpac and its user-defined workflow parameters. Claims may be routed according to high dollar, specific diagnosis and other review criteria. |
| Fully-integrated Claims Edit system stops costly overpayments |
| Medical overpayments attributed to up-coding of claims can automatically be detected and corrected. The system identifies surgical, laboratory, radiology and medical procedures that are inappropriately coded, and, at the user's option, by group, automatically corrects the errors. |
| Support for virtually any fee schedule ensures appropriate payments |
| The platform supports virtually all pricing databases such as medical, dental, anesthesia as well as specific user-created fee schedules. |
| Electronic Data Interchange speeds processing (incoming-outgoing) |
HIPAA-compliant claims and related transactions can be directly received or expedited electronically through our X-12 Manager.
|
More
|
![[+] Enlarge this image](javascript:openWin('../images/claims_process_big.gif','win1',690,725)){kind=link}
![[+] Enlarge this image](javascript:openWin('../images/claims_workflows_big.gif','win1',870,620)){kind=link}