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Claim Processing

Claims Processing:

   The complete procedure of entering the measures rendered until payment is collected or denial is determined is called claims processing. iSourceindiaindia is an efficiently managed Medical Transcription Service company maintaining very high standards in providing clear information management services to US clinics and hospitals. iSourceindiaindia's mission is to provide its client with acceptable claim processing services. iSourceindiaindia have the claim processing services to increase the benefits of our clients located all over the country.

   To serve the clients of claims processing system with the utmost care and efficiency, the Organization needs to settle claims on their insurance within 10 days to avoid penalties. With approximately 7 million claims holders globally in the Organization's database, each patient receiving care, has the possibility of bringing anywhere from one to 19 forms available to the center for processing which includes standard and non-standard, Medicare, dental, medical and voucher forms. The volume is tremendous, and the customer knew that outsourcing the data entry of claims would be very critical to meet the 10-day deadline.

How we Work

   On a daily basis, images are received from a “image” team at the Organization, and uploaded to iSourceindia's offshore facilities. Images are then distributed to iSourceindia 's keying sites. At the completion of the data entry process, iSourceindia electronically sends the data to the Organization to upload into their system. This key data entry process consistently delivers data to the Organization in less than 36 hours, and thus they can easily meet the 10-day deadline to efficiently serve their patient community.

   The Organization is thrilled with the level of services and quick turn around times offered by iSourceindia. Claims are settled within 10 days, and a higher percentage of claims are now automatically adjudicated without delay resulting in quicker payments to providers and insurers. iSourceindia 's quality measurements, established through our Total Quality Management process, have exceeded the Organization's requirements for months, and they have seen significant improvements to the already short turn around times. In addition, iSourceindia worked with the Organization to determine the precise output data needed and worked to address all the issues and concerns in less than 18 hours from receipt.

   Over the course of the few years, iSourceindia has worked with the Organization to deliver a quality end result. iSourceindia has reduced errors in such areas as scan quality, denied claims and illegible data. With guaranteed accuracy rate of 99.3%.

   By outsourcing your claims processing to our company, we will be able to process claims faster and more cost effectively than performing the work in-house. Your bottom line will benefit from:

Learn more about our Global Sourcing and Service Delivery

Guaranteed 48 hour processing time irrespective of the claim volume.

Guaranteed accuracy levels exceeding 99.3%.

Real-time web based Work in Process reports.

Guaranteed capacity of programmers, processors and data engineers to meet your impromptu requests.

Quality and process control through ISO9001 and Six Sigma methodologies.

   We are able to convert different claim types in less than 48 hours with a 99.3% or higher rate of accuracy. We pride ourselves in being one of the only industry providers to process Explanation of Benefits, payments, enrollment and referral documents. And with the capability to reduce your adjudication costs by up to 45% we have established ourselves as the leader of Business Process Outsourcing in the claims processing industry.

   We view the claims process event as entirely linear. A claim comes into the facility through the mail. It is received, opened, batched, grouped and scanned by us. Next, the scanned claim is electronically sent to one of our in house data capture facility, where the claim is keyed and converted into the customer specified output. The output data is then downloaded into the customer's desired adjudication system, where we will adjudicate the claim according to the specific rules of the insurer's plan.

After adjudication the claim can be uploaded into a document management system, or into our on-line storage solution.

Breaking Down the Process

   Outsourced Claims Receiving Units, can instantly save insuring organizations precious time and resources. We receive your mail at our facilities or onsite at your location.

Document Scanning

Our vast array of resources allows us to image claims either at the customer location or at one of our strategically placed facilities.

We also provide premier document security. While your documents are with us, we:

Account for each and every claim coming out of your facility.

   Establish a tracking convention unique to your organization's business rule, allowing us to guarantee deliverables.

   Once the claim is digitized, the image is routed to our data capture facilities. Each unique image is tracked throughout our quality intensive conversion process. Utilizing our Quality Certified Processes and TQM methodologies we guarantee quality levels exceeding 99.3%.

   The converted output is then downloaded into the customer's system. We will then remotely access the customers' system and manually adjudicate all claims that are not accepted through auto adjudication, according to the customer's business rules specification and plan specification.

Online Document Storage & Retrieval

   Our overdue solution for the claims processing industry. The prevalent need to store, retrieve and archive large volumes of paper and data, requiring access by several internal and external sources, has organizations scrambling to stay afloat. Additionally, document management creates a virtual customer service department, so you no longer have multiple disjointed customer service locations, but rather one single, virtual platform all customer service representatives can utilize.

Quality

   We very strongly feel that quality and accuracy are our primary importance. And, even though turnaround, cost and efficiency are important, quality is always our overriding concern. This is why we have adopted extremely redundant quality control procedures.

   Our quality systems and corporate operations and methods are high class, which are trusted by the top organizations for their ongoing business. Our commitment to quality is reflected in numerous satisfied repeat customers for past years.

   We have established effectively implemented quality systems and procedures, which were developed by the founder with more than 10 years of data processing experience.

   The first step in achieving highest quality is training. We always assign dedicated team of people to work on every project. All people go through a intensive training program before they start working on any new project. A dedicated project manager is also assigned for the project to manage all the communications with the customer and the data processing team.

   The high level of consistent quality is achieved by maintaining all data documents received for processing. When a job is received it is batched and each batch of documents is assigned a batch control log. Operators log out batches for keying and verifying.

   Quality Control is accomplished by continuous key operation of selected batches to assure guaranteed accuracy. Key verified work using double keying is guaranteed at an accuracy rate of 99.995%. Unverified work is guaranteed to be 97% - 99% accurate. Of-course, we always strive for 100% accuracy.

   Custom error checking programs are written for every project to improve quality. Database lookups and are implemented as part of keying process whenever possible to achieve the best quality.

   All projects are quality controlled by Quality supervisors who randomly check operators for continuous accuracy. New operators are checked 100% until they become familiar with the project and meet our quality requirements.

Benefits of Solutions offered by iSourceindia

  • Lesser staff and space required to manage the front-end claims processing
  • Our Group experience with latest claims processing transaction sets
  • Provides a known cost for expanding business services
  • More accurate processing & front-end eligibility verification (less work in adjudication)
  • Ability to concentrate on core business & customer satisfaction
  • Security of having multi-site processing capabilities
  • Security of having off-site file backup
  • Improved workflow efficiency and communications with claims processing documents.

 

   In the healthcare field, iSourceindiaindia uses only world-class health care service providers. They work efficiently and effectively to free you to concentrate on your core business. Check out links below to know more about our specific services. If you don't see what you're looking for, you can send us your request using this questionnaire. Our claim processing service representative will call back or reply to your queries shortly.

 

 

 

 

 


 
 
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