BPM services – to assess, document and analyze existing process flows and technology and recommend a “To Be” administrative approach including processes and technology. Our objectivity and experience allows us to either recommend improvements to existing systems or newer, stronger rules based technology. Our experience tells us that virtually every payer process depends on consistent and accurate rules application to determine eligibility, payment accuracy and limit processing exceptions as well as effectively resolving exceptions when they do occur.

Consulting services – to address the strategic and tactical requirements needed to meet the imminent deluge of change reforms will generate. Key areas include improved enrollment processing and how to most effectively plan and execute the conversion of HIPAA 5010 and ICD – 10 – CM. The latter effect virtually every system, process, provider and member interface in processing claims.
Considerable planning is needed to address various levels of training in different functional areas as well as system modifications to deal with the over 850 complex HIPAA 5010 changes, increased diagnosis codes from 13,000 to 67,000 and facility procedure codes from 13,000 to 87,000. Industry consensus is that these mandates alone will dwarf the Y2K conversion.

The combination of these mandates and the legislative reforms to be implemented in the same time frame will place unprecedented pressures on payers. The funding and resources necessary to deal with all of these as well as running the day to day business will make it difficult, if not impossible, for payers to meet deadlines with existing staff and expertise.

We offer Providers a full range of Business Process Outsourcing (BPO), Revenue Cycle Management, Consulting, and Business Process Management (BPM) services designed to reduce costs, improve business processes and maximize technology. Intelenet is totally objective in selecting the most effective technology to suit each client’s specific needs or to maximize existing system performance.

Recognizing that every provider must satisfy local regulatory, business and customer needs as well as national and entitlement program requirements we specialize in tailoring solutions, and avoid cookie cutter approaches that require changes in your business models.

Business Process Outsourcing Revenue Cycle Management Services include both pre – billing and post – billing administration that impact revenue streams and receivable aging. Our domain expertise enables us to offer a full range of services including:

Intelenet is fully HIPAA compliant and has coders on staff already fully certified in ICD – 10 – CM aimed at relieving clients of having to retrain or hire new coders to meet the mandate.

BPM Services complement our outsourcing approach and provide clients with both initial and ongoing analysis of existing business processes that lead to “To Be” recommendations. We offer clients the option of upgrading existing systems or suggesting replacement systems built around solid rules applications. Our goals are to:

Consulting Services are designed to develop both strategic and tactical solutions to the many changes that government healthcare reform and unfunded mandates will impose. These reforms will place significant burdens on the industry to fully comply with regulatory requirements of CMS and RAC audits with the threat of financial penalties and sanctions for non-compliance. This is a critical consideration given the Federal Government considers such penalties to be a revenue source.

Intelenet’s healthcare domain experts offer years of experience in day to day operations in all aspects of provider functions as well as executive level management experience that offers a full understanding of payer, government and regulatory requirements and how providers can best interact with each other.

It is now becoming clear that major changes to the healthcare industry are going to occur. One of the most significant issues providers face is the continued reduction in payment for services under Federal and State entitlement programs. Programs will grow under Universal Access and partnering with Intelenet will go along way in reducing administrative costs while maintaining and improving performance.