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Knowledge processing Outsourcing services
The health insurance sector is becoming more competitive and new operating models are coming into the spotlight. In a dynamic business environment, medical insurance payers must sustain their efforts in marketing and enrolment, building customer retention, and striking a balance between their profitability, purpose and perceived value. When it comes to medical insurance claims processing, the challenges are multi-faceted – volume, accuracy, speed of processing, administrative costs and regulatory compliance all have a hand in improving customer satisfaction.

Services

  • Data entry of patient demographics, referring physician, CPT and ICD Codes, and Modifiers is entered into the medical billing software
  • Scan the documents for billing errors and correct them if needed
  • Adjudicate client claims for accuracy
  • Submit and file the claim with the insurance company
  • Follow up on the claims with the insurance company
  • Apprise you of the status of the claim
  • Provide IT solutions
  • Medical Coding and Medical billing
  • End-to-end Claim Processing:

Our comprehensive set of Claims Processing services manages all the facets of a health insurance claim. We ensure superior, faultless and low-cost output for our client’s claims, while utilizing our personalized, audit-quality process documents for regulatory compliance initiatives and training purposes. Our services include:

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Real Time Claims Processing

Calculation and Processing of payments to providers in case of direct billing Calculation and Processing of payments to clients in case of reimbursement cases
Data Entry Services
Digital Image Processing
Data Cleansing
Periodical reconciliation of payment with the client’s system and federal bodies.
KPO’s claims adjudication approach is simple – engaging a team of experienced and qualified claims adjudicators and a team of IT professionals to deliver efficient adjudication solutions to payers. By availing our services you experience a blend of people, processes, systems and technology that ensures exceptional quality, increased efficiency and significant cost savings.

Role of KPO

Reduce Cost

– Optimizing manpower
– automating processes
– Stricter control of claims

Control Fraud/Abuse

– Control over all surveys
– Repository of data for cross matching

Improve Turn Around Time

– Workflow based e-process
– Digitization of documentation
– Automation

DMS Paperless environment

– Reduce movement of files and paper
– E-approvals

Periodical reports on claims statuses as well as work-progress

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