Healthcare
The healthcare industry continues to grow, but remains highly competitive with downward cost pressures. Increasing medical premiums and higher medical costs have led to slowdown in employer-based enrollment plans and the possibility of some form of Universal Health Care. As purchasing patterns shift toward self-funded employer plans, there is an increasing pressure from payers and employers to contain costs through new product innovation. Insurers are looking to market new products and services and quickly respond to market changes, leading them to consider alternate delivery options.
Patni’s Healthcare practice presently serves the following constituents: Payers, Providers and Clearinghouses. The domain expertise gained over the last two decades for each of these constituents includes:
Payer
Plan Definition, Eligibility and Enrollment, Policy Servicing, Billing, Claims Processing, Claims Adjudication, Benefit Management, Provider Management and Member Services
Provider
Provider Management, Claims Management, Patient Information and Financial Management, Clinical Data Management, Pharmacy Benefit Management and Revenue Cycle Management
Clearinghouse
Claims processing, Payment processing, Collaboration among QUWEST, NACHA, ACH, and HCFA & UB04 conversion.
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Our integrated IT and BPO service offerings includes Claims as a Service™ which allows smaller health plans to scale their business at a variable cost. The HIPAA 5010 and ICD-10 Conversion solution assists organizations right from the initial assessment phase, through implementation and beyond, to ensure a smooth transition and meet regulatory timelines. The Long Term Care claims framework helps healthcare insurers integrate claims processing with the Plan of Care, to create transparent and manageable business logic for consistent and accurate claims adjudication, and provide standard claims reporting and enhanced claims analytics.
Ranked as the #1 BPO provider in delivery excellence and length and breadth of its service offering by the Black Book of Outsourcing, Patni offers its customers the access to 250+ claims examiners with 4+ years experience in adjudication and 150+ enrollment specialists with 2+ years experience in enrollments & billing. Our end-to-end Healthcare BPO offerings include:
Select Success Stories
HIPAA compliance for electronic payments by developing Electronic Payments System
To comply with Health Insurance Portability and Accountability Act of 1996 (HIPAA), clients must provide the necessary infrastructure to process Health, and P&C claim payments electronically. Patni experts designed a documentation solution – an integrated system that bundled the EFT system to handle a high volume of transactions.
Claims Adjudication for a Leading Medicare Carrier
An existing IT & BPO customer of Patni wanted to rapidly deploy an robust off-shore solution for Claim processing/Adjudication. Patni deployed a team of consultant specialized in all kinds of claims adjudication: Medical, Hospital, Dental, and Vision. The solution processed an average of 18,000 claims per day.
Compliance to U.S. government regulations for Medicare D program
The client was looking for an IT solution to incorporate U.S. government regulations for Medicare D program. Patni team developed an Intranet based utility Re-Enrollment Tool (RET) to facilitate modifying details of existing enrollees. The successful handling of Part D applications helped client leveraged its position as a strategic player in the U.S. Medicare market.
Replacing two commissions systems with a single commission calculation and disbursement system
One of the world’s largest Health insurers need was to replace existing two commissions systems with a single system. The project entailed requirement analysis and design and system/integration/UAT support under Patni’s Test Management services. The client benefitted from better ROI through integrated processes, accelerated implementation of strategic platform, and effective usage of package functions.