Claims processing forms an important component in the overall claims process, significantly impacting the bottom lines, relationships and reputation for insurance providers, Third party administrators (TPA) and self-insured corporations alike.
Though the claim processing has been evolving towards automation, a significant part of the overall process still requires manual intervention. Insurers may consider outsourcing this part of the process to organizations having in-depth expertise, technology, proven process and experienced resources that can be relied upon.
4iSoft has built its Claims Processing Service based on these 4 tenets –
Efficiency– Leveraging the state-of-art technology platforms, employing trained and experienced resources and working through a tried and tested process flow.
Accuracy – Claims are honored for the right claimant for the right amounts as per the policy terms, avoiding duplication and weeding out fraudulent claims. Our existing SLAs mandate accuracy levels of 99%, which we have exceeded consistently.
Turnaround Time – Claims processed within 24 to 48 hours with no or little backlogs.
Cost Effectiveness – Using a blended delivery model of on-shore and off-shore resources to optimize service levels and costs
4iSoft shall provide you with a dedicated team of claims adjudicators and analysts, who would support you through the entire claims process, acting as an extension of your in-house team.
4iSoft has the right expertise to provide processing services for following claims:
- HCFA claims 1500 / CMS1500
- UB92 (Single / Multi / Attachment / COB)
- Dental Claims
- RX claims
- Foreign claims
- Medicare RP
- Miscellaneous (Complex / non-standard)
- Pends / Correspondence
- Enrollment Forms Processing (EFP)
- Vision Claims
Insurance Claims Processing Workflow
4iSoft uses a tried and tested process, but is flexible to accommodate the required changes as per client needs.
Our standard claims adjudication process includes the following steps:
- Receive Claims
- Eligibility Check
- Check for Duplicate Claims
- Benefit Determination Application
- Verify Provider Details
- Coding, Bundling & Diagnosis Review
- Rules-based Edits
- Claims Settlement
- Claims Presentment
4iSoft – Partner of Choice for Claims Processing Services
4iSoft has been the partner of choice for leading insurance providers, TPAs and Self Insured entities due to
- Adherence to its 4 tenets of Efficiency, Accuracy, Turn-around time and Cost effectiveness
- Deep understanding of process, by virtue of its experience with leading P&C players.
- Proficiency on multiple claims and bill review platforms
- Trained and experienced resources willing to travel that extra mile
- Flexible engagement models to suit your needs