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Our advanced technology platform is real-time, scalable, and Web-enabled. The consumer-centric
data model provides a complete view of each individual member across all products and services. And
we can manage all or portions of your health plan’s back office functions – it’s up to you.
Our core services include:
- Enrollment
- Premium Billing, Collection & Reconciliation
- Provider Network Management
- Claims Processing and Adjudication
- Encounter Administration
- Customer Service and/or Provider Services
- Capitation/Risk Pool Management & Reporting
- Financial Processing & Payment
- Print Fulfillment, ID Card Printing and Fulfillment
- Consumer-Directed Accounts (FSA/HSA/HRA)
- Debit Card Administration
- COBRA/HIPAA/NYHCRA Administration
- Retiree Billing
- Life Insurance
- Fraud Management
- Pharmacy Benefits Management
- Care Management:
- Utilization Review
- Case Management
- Disease Management
- Demand Management
- High-risk Pregnancy Management
- Behavioral Management
- Nurse Information Line
- Health Risk Appraisals
- Health Promotion Programs
- Preventive Medicine Programs
- Web Portal Access:
- Web/IVR Enrollment & Eligibility Self-Service
- Web Billing Administration
- Web Claims & Provider Information
- Web Provider Search & Selection Tool
- Web Consumer Decision Tools
- Paper Conversion Services (Imaging/OCR)
- EDI
- IVR
- Email Desk Top Support Services
- Help Desk
- Data Analysis & Predictive Modeling
- Data Warehouse
- Legacy/vendor Integration
- Interface Development & Maintenance
- Fraud & Abuse
Our fully integrated technology platform and business process allows us to be responsive,
quick and flexible in designing solutions for your needs. Our managed care core processing system
runs in a secure, hosted data center environment with unparalleled security, capacity, connectivity
and reliability. That means you need minimal investment in hardware and software and you'll have
ongoing relief from future development, maintenance and upgrade costs.
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