Post on 12-Jun-2015
description
a better way to workTM
for Healthcare
Approach for Health Payers
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Replicates a high percentage% of existing processes being performed manually
Decreases cost - reduces the number of claims requiring a human to process
Utilizes your existing applications and current claims processes
Low IT and business resource footprint
Offers value in 30 days and fully implemented in less than 6 months
Provides near-immediate triple digit ROI
Emulate the observations, decision and actions – or more simply, the
eyes, brains and hands – of your claims examiners.
Access the data necessary to settle a claim without requiring IT
resources to build services, provide APIs or develop extracts.
OPENSPAN PROPRIETARY & CONFIDENTIAL 4
Overview
Solution Lifecycle
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Implementing the Claim Automation Service Your numbers may vary
Use Case Examples
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Pre-X
Wellness
Duplicate Checks
Provider Management
Prompt Pay
Authorizations
Adjudication Edits
Pricing Overrides
Capitation
Tiered Benefits
Corrected Bills
Coordination of Benefits
Processing Paper Claims
Claim Status Checks
Policy-level Checks
Large Claim Review
Claim Audit
Data Quality Checks
Data Formatting
Out of Network
Provider Updates
Medical Record Review
Auto Log In & Refresh
Customer 360
Transferred Call Data Share
Caller Verification & Disclosure
Application Set Up
Application Synchronization
Previous Call History
Real-Time Guidance
Process Simplification
Validations
After Call Notation
OPENSPAN PROPRIETARY & CONFIDENTIAL
Engagement Path
• Client pain point
• Benefits assessment
• Technology diligence
• Proof of concept
• Prioritize automation opportunities
• Build and implement claim automation service
• Build and implement claim optimization
• Build and implement contact center optimization
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OpenSpan Investment in business relationship with client
OPENSPAN PROPRIETARY & CONFIDENTIAL