Case Studies / Healthcare

Inbound/Outbound Services and data services offered to an US Health Care Company

About the Client

The client is a health care information company that enables health care providers, hospitals, billing companies, payers and equipment vendors to manage cost effective health care delivery and reimbursements.The client uses hi tech systems to incorporate artificial intelligence to empower health care constituents. The Client is based in USA.

Goal of the Client

To provide better services to its customers while getting tremendous cost reduction on their operations.

Challenges

  • Need of highly educated professionals.
  • Need of experienced technical team.
  • High attrition rate.
  • Good infrastructure.
  • High tech systems.

Requirements

Compliance and standard requirements, viz HIPPA and HL7. Six sigma implementation on the overall process execution. Use Client management and information system. Compliance and Improve Liquidation Ratio.

Solution by VSynergize Outsourcing

  • World class infrastructure for contact centre and management.
  • Best in class manpower with high skilled and professionals.
  • Coverage issue.
  • Financial outcomes, i.e. reimbursements.
  • Clinical policy.
  • Utilization guidelines.
  • Coding edits.
  • Line-item information contained in insurance claim or remittance statement.

Benefits to the Client

Unique web-based pre-adjudication system increases profitability by identifying avoidable denials and recommending solutions before claims are submitted to payers. All Payer solution utilizes a Rules Based Engine and a proprietary database to target potential denials or delays in payment with payer specific insight on how to minimize uncompensated treatments.

  • There was more collection possible and hence the productivity largely increased.
  • The clients were able to get more business as they were over achieving the target with VSO's assistance.
  • VSO assisted the client getting rid of non productive manpower and providing with highly productive collection agents.
  • We import claims – uploaded to our secure message center as attachments.
  • Avoidable denials and solutions are reported to via the web.
  • Reviewed and corrected claims are submitted electronically to payers.
  • More than 60% reduction in operation costs for the Client.
  • Helped client getting more business.

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