Insurance Claims Management Services - Insurance Claim Processing & Insurance Claim Management
This information is intended as a general reference only. You should thoroughly review your policy so that you are aware of specific definitions and conditions that apply to the insurance coverage you purchased.
"Insurance policies are contracts between you and your insurance company. You should understand the policy before a loss occurs. Review your policy with your insurance broker so you'll know what's covered."
Our offerings include services along the following functional aspects of claims management systems:
- Yantrambpo's IT/Process outsourcing solutions ensure cost and advanced process engineering savings that are critical to healthcare outsourcing and claims management functions and processes. Yantrambpo provides an Integrated IT/ BPO Solution for claims management through which we develop and manage your claims technology platform.
- Progeon, Yantrambpo's BPO arm, works seamlessly to leverage our technology strengths in managing health insurance claims processing.
- Our services strive towards complete implementation of automated end-to-end process flows until the claim is successfully resolved.
These services include:
1. Pre-adjudication
2. System routing
3. Pricing
4. Pend resolution and adjudication system response
5. Development of workflows for planning
6. Tracking manual interventions
- Drawing on our vast experience with leading payer organizations, we offer you strategic solutions to merge all the adjudication engines into a single health insurance claims processing system. Our solutions help your business achieve uniformity and integrity, and have significantly reduced system maintenance costs.
- We can enhance your system capabilities to meet the latest policy/ legislative regulations, increasing systemic capability to handle more system lines. This results in better co-ordination of your claims payments. Our services can increase systemic capacity to trap claim edits. We can apply uniform code-sets across multiple systems, enforce HIPAA privacy and security compliance or enhance the capabilities of your systems to process new products.
- We bring complete expertise of business rules for adjudication processes and familiarity with industry practices. All our services adhere to HIPAA mandates and
standard code sets. Our experience base spans across a variety of claims such as Individual physician, Institutional, behavioral health, pharmacy and dental.
- We help you handle all functionalities such as payment to providers, generation of EOBs and EPPs, integration with authorization engine, response to claim status enquiry and development of claim remittance advice.
Benefits of our Insurance Claims Management Services
Insurance Claims Reporting
Professionals at our Insurance Claims Reporting Center are available 24 hours a day to take reports by toll-free call, fax, or over the Internet.
Your notification triggers the electronic claim file setup and alerts an early intervention nurse if needed.
Insurance Claim Handling
All claim file documents are imaged at a central facility and electronically routed through a network to the appropriate claims handler, who then works from a virtual file. This handler uses an integrated claims workstation that allows him to manage and deal with all aspects of a reported loss electronically. In this electronic environment, we can collaborate more easily with each other and work with colleagues in other areas - from managed care and litigation management to salvage and subrogation.
Because Yantrambpo has many facilities nationwide, the insurance claims management specialists have become familiar with local laws and regulations pertaining to their specialty area. This brings an added skill set to the insurance claims processing and management.
Insurance Claim Management
Litigation is reduced when claims are responded to promptly. Yantrambpo attends and responds to every enquiry made.
Yantrambpo's Insurance Administration Software Systems
Yantrambpo has provided insurance software solutions for some of the largest names in the insurance industry. Our full line of Insurance Administration Software Systems and Solutions can be tailored to meet the needs of a wide range of organizations including Insurance Carriers, Third Party Administrators (TPA), Trade Associations, Self-Insured Funds and Trusts, Fraternal Organizations, Health Plans, Labor Unions, Employee Benefit Funds and Claims Processors.
The benefits of Insurance Administration Software Systems can include:
- Up to 15 percent reduction in settlement costs.
- A 20 to 30 percent reduction in the cost of claims management.
- A 25 to 40 percent increase in the number of claims closed "once and done."
- Lower IT costs.
- Dramatic service improvements.
Contact us to find out how Accenture can help achieve high performance in claims.