Payer Portal
This is a one-stop solution for all-payer requirements. It has configurable workflows that enable the users to easily manage end-to-end workflows, starting from enrollment to claims payment, collecting & viewing member benefits, and claiming history on their fingertips using a mobile app and web portal. It connects all the parties on one unified platform, which makes claim processing faster & easier. It also offers a seamless view of claim status to members, providers & payers. Additionally, the complete suite provides independent modules like credentialing, Grievances and Appeal (G & A), Utilization Management (UM) & Business Intelligence tools that seamlessly integrate with other legacy applications.
Key Features
- Built-in contracts management and rule engine for a faster claim’s adjudication process
- Collaborative portal to bring stakeholders for communication and tracking of claims
- EDI integration (e.g., 835, 837) for electronic transfer of data according to regulatory guidelines
- Workflows to manage the entire lifecycle of claims origination to payments
- Notifications for updates and pending actions for claims
- Advanced analytics and reporting for claims history, payment history
Technology used
- .Net, MSSQL, Tableau, HTML, JS, AJAX, bootstrap
- Cloud Hosting – Azure & AWS
Advantages
- Centralized record management and claims adjudication process
- Streamline processes to speed up payments through workflows and analytics