We provide innovative industry solutions for healthcare payers.

Rising healthcare costs, service demands, administrative expenses, and the need for improved payer-provider-patient interoperability are driving payers to accelerate digital transformation. With over 100 payers relying on ServiceNow, our platform minimizes plan administration costs, boosts compliance capabilities, and improves customer satisfaction. Leveraging our extensive healthcare payer technology experience, we develop solution accelerators on the Now Platform.

CLAIMS EXCEPTION WORKSPACE

CHALLENGE

Healthcare payer organizations face costly and inefficient processes when dealing with claims exceptions. Manual methods result in rising expenses and frustration for employees, providers, and members. With claims exceptions occurring 10-20% of the time and costing over $10 per claim, there is a significant opportunity for savings and improved efficiency.

These manual processes generate unstructured and ungoverned data, making tracking, reporting, and analysis laborious and error-prone. The absence of regulated and structured data hinders the ability to measure, understand, and enhance the process.

Additionally, without the right data, it becomes impossible to assess progress against external Service Level Agreements and internal Operational Level Agreements.

SOLUTION

Claims Exception Workspace (CEW) seamlessly integrates with any healthcare payer claims platform, enabling you to optimize workflow efficiency across your entire enterprise and accelerate value realization.

Key Benefits:

  • Improve operational efficiency to maximize impact
    Never miss a required step or task with a low-code solution that implements a find, frame, and fix approach.

  • Enhance employee, provider, and member experiences
    Connect people, process, and technology with a single pane of glass for increased transparency and improved CSAT.

  • Control costs and mitigate risk
    Improve efficiency, accuracy, and security to unlock untapped value, reduce costs, and mitigate organizational risk.

FRAUD, WASTE, & ABUSE WORKSPACE

CHALLENGE

Health insurance companies face significant challenges in combating widespread fraud, waste, and abuse. The National Health Care Anti-Fraud Association (NHCAA) estimates annual financial losses in the tens of billions of dollars due to healthcare fraud.

Lack of structured data consolidation impedes the ability of employees to measure, comprehend, and improve processes. Manual processes generate unstructured and ungoverned data, resulting in arduous, error-prone tracking and reporting.

Without the appropriate data, measuring progress against external Service Level Agreements and internal Operational Level Agreements becomes unfeasible.

SOLUTION

esolutionONE's Fraud, Waste, and Abuse Workspace is a versatile solution that integrates with healthcare payer data sources, streamlining enterprise-wide FWA investigations and enhancing value realization.

Key Benefits:

  • Improve operational efficiency to maximize impact
    Never miss a required step or task with a low-code solution that implements a find, frame, and fix approach.

  • Enhance employee, provider, and member experiences
    Connect people, processes, and technology with a single pane of glass for increased transparency and improved CSAT.

  • Control costs and mitigate risk
    Improve efficiency, accuracy, and security to unlock untapped value, reduce costs, and mitigate organizational risk.

We’re ready to discuss, understand, and collaboratively create a tailored solution that solves your unique challenges!