Healthcare Payer Services

Our healthcare payer services cater to dynamic requirements seamlessly. We help you reduce costs, optimize resources, and improve operational efficiencies so you can focus on quality care for your patients.

Our payer services teams identify trends and patterns in healthcare utilization, expenses, and quality care. This can inform decision-making and develop strategies for managing costs and improving outcomes for your business.

Our experienced team of experts meet the evolving needs of your healthcare members and companies.

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Risk Adjustment

We can improve healthcare outcomes and reduce costs by implementing effective risk adjustment strategies. This means we’ll ensure that healthcare costs are allocated efficiently based on the healthcare needs of individual patients.

Cost projection
Hierarchical Condition Category (HCC) coding
First and/or second pass

Chronic Care Management

We can help coordinate support for patients with chronic conditions. Our chronic care management can help to improve healthcare outcomes, reduce costs, and enhance the experience of patients.

Case management and intervention
Discharge planning
Follow-up and transition
Interdisciplinary plan of care
Predictive risk stratification

HEDIS

HEDIS is a set of standardized performance measures used by payers to evaluate the quality of care provided to their members. This can demonstrate your commitment to high-quality care, identify areas for improvement, and improve outcomes.

Analysis and identification of gaps in care and closure
HEDIS measurement
Member engagement
Provider credentialing
Provider engagement

Utilization Management

Assess the medical necessity and appropriateness of healthcare services before it happens. Utilization management helps control unnecessary expenses at all steps of the healthcare journey.

Clinical intake
Pre-authorization
Concurrent reviews
Retrospective reviews
Appeals
Peer review prep

Supplemental Data Review

We can evaluate and verify additional information provided by healthcare providers to support claims for reimbursement. This includes clinical documentation, medical records, or other relevant data.

Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Health Outcomes Survey (HOS)
HEDIS reporting (NCQA)
Member feedback
Review of patient complaints, grievances, and appeals toward the provider
STAR rating