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Intelenet offers
Payers outsourcing and process improvement services designed
to increase performance while significantly reducing
administrative costs. Our domain expertise includes many years
of hands-on Payer day-to-day processing and executive
management experience. We understand your business, your pain
points and what is necessary to resolve them.
Legislative reforms and unfunded mandates
are going to place considerable new burdens on the industry
that promise to increase underwriting risks and administrative
costs. Partnering with Intelenet can mitigate many of those
risks due to our proven record of performance in Business
Process Outsourcing (BPO), Business Process Management (BPM)
and Consulting Services.
The combination of Universal Access
reforms and unfunded mandates such as HIPAA 5010 and ICD-10-CM
conversions come with a potential resource and
cost drain of monumental proportions.
Our multiple dimensional approaches to
dealing with these issues include:-
BPO services -
are provided for outsourcing labor intensive
services in Member Management, Claims Management, Call
Centers, Financial and Accounting processes. Coupled with our
unique ongoing business process improvement techniques we
continually monitor work flows, rules applications and
technology. Our goals therefore are not simply to reduce costs
due to lower personal services costs but to continually
improve administrative processes to minimize exceptions.
Specifically we can:
- Reduce the time of initial
enrollment process from agent contact to final acceptance
thereby increasing agent, broker and most importantly, new
member satisfaction. These will be especially important as a result
of Universal Access reform and the accompanying
compliance issues it will impose.
- Increase first pass claims
processing performance by improving the application of
eligibility rules and strengthening manual processes and technology. Intelenet
is technology agnostic and therefore is
totally objective in recommending technical improvements.
- Improve
Financial and Accounting practices in Accounts Receivable, Accounts Payable, General Ledger administration, Payroll and HR.
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.
PROVIDERS
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