Healthcare & Insurance
The healthcare industry faces tough modern-day challenges – Coping with rising healthcare costs, ensuring timely payment processing, accurate invoicing, and keeping up with regulatory changes – the list is endless. Increasing cost pressures, sweeping shift towards individual plans, and market fluctuations, healthcare payers are struggling to lower costs and retain their competitive position.
A critical aspect – Healthcare policy billing, usually includes Issues around claims, payments, and invoice management resulting in revenue leakages at the cost of patient experience & business growth.
Using RIA’s expertise, healthcare organizations can embrace the right solution for their revenue management.
Fully Insured Health Plans
- Accelerate time to market in COVID-19 scenario
- Replacement and consolidation of legacy billing systems
- Providing end-customers flexibility to generate accurate invoices through self-service
- Enhanced UX
- Eliminate revenue leakages
- Easy integration with existing IT systems
ASO Health Plans
- Premium and fee calculation ability depending on qualifying events such as member termination, addition, etc.
- Clear view of whom to charge and what to charge
- Seamless capability for building flexible pricing models based on customer relationship
- Eliminating billing confusions, introducing billing accuracy
Dental Health Plans
- Replacement of different Billing and AR system (causing discrepancies) with a single system
- Powering the client’s own shop, quote and enrolment setup for direct plans and interface to policy admin
- Complete policy lifecycle management with retro-effective capabilities for new enrolment, updates to policy renewal, termination and re-instatement of policy
- Paid-through date calculation and interface to claims system
Plugging revenue leakages
Pharmacy Benefit Management
- Robust solutions for pharmacy rebate billing and receivables management
- Replacement of legacy systems with streamlined automation
- Revenue process transformation
- Big data solutions for pharmacy benefit management to cope with ever increasing volume of data
- Real-time integrations with upstream and downstream systems
- Highly scalable and robust payment application
Provider Revenue Management
- Innovative and integrated care pricing
- Relationship based pricing
- Cross-selling insurance products
- Replacement of legacy systems
- Process efficiency through consolidation
Claims Administration
- User-friendly claims product and benefit definition for business users
- Streamlined provider contracting and claims pricing
- Smart and automated claims adjudication
- Integrated management of authorizations
- Advanced rules-based architecture with a strong model for data and process extensions
- Engineered to manage large volumes with proven scalability
- All-encompassing SaaS solution on secure and scalable Oracle Cloud Infrastructure
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Policy Administration
- Streamlined management of groups and memberships
- Automated enrollment processing across multiple channels
- Effortless premium calculations with automated retroactive adjustments
- Full data transparency to ensure excellent member service
- Advanced rules-based architecture with a strong model for data and process extensions
- Built to manage large volumes with demonstrated scalability
- All-inclusive SaaS solution on secure and scalable Oracle Cloud Infrastructure
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Authorization Management
- Comprehensive management of authorizations, notifications and referrals
- Capability to receive authorizations from various case and clinical management systems
- Option to manually enter one-time authorizations directly into the health insurance management system
- Flexibility to have authorizations in terms of amounts, units, or time periods
- Unlimited service lines per authorization
- Ability to capture detailed data and attachments with each authorization
- Fully customizable preauthorization matching rule
- Designed to handle large volumes with scalable architecture
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