Business Process Outsourcing for Payers and Health Insurers

Redirect resources to business-building core capabilities— take advantage of cost-effective, high-quality outsourced Business Process Solutions for Payers and Health Insurers from Dell Perot Systems.

Challenge
For Health Insurers, the rising cost of business processes and the constant need for qualified staff can distract from core business functions and the pursuit of business growth. And when margins are tight, capital expenditures for IT are often put off until obsolete technology and sluggish processes threaten not only further revenues but patient and physician satisfaction.

Solution
Dell Perot Systems can help, with outsourced transaction processing for claims administration, adjudication, and member services. Similar to our Extended Claims Administrative Office Services, outsourced Business Process Solutions provide powerful tools to help payers reduce administrative costs, improve performance, avoid technology obsolescence, resolve variations in operations, and reduce capital investment in facilities and systems.

These services are provided through a longer-term, blended model, leveraging offshore costs with domestic functional expertise. This enables us to deliver efficient, high-quality processes at competitive prices by assuming responsibility for all health plan business office functions. Our global network of transaction-processing centers provides both the state-of-the-art technology and exceptional service necessary to ensure seamless transaction processing and operational support. Our BPO services include the complete spectrum of health plan administration functions:

• Claims entry/vertexing
• Claims adjudication, including repricing, eligibility and coverage verification, provider verification, diagnosis and treatment reconciliation through CPT and diagnosis codes
• Eligibility
• Membership services including benefit information, adds, and changes
• Provider updates, adds, and changes
• Provider credentialing preparatory work
• Inbound customer care for members, providers, and agents

Results
With Dell Perot Systems® Business Process Outsourcing, your payer organization can enjoy:

• Easy transition. Your systems and processes are transferred with minimal change or disruption to existing procedures.
• Freedom to focus on business-building core capabilities.
  Our experience in providing end-to-end billing services for providers and our knowledge of multiple specialties, state regulations, and health plans enable us to adjudicate claims quickly, accurately, and cost-effectively so you can focus on building your business.
• Compliance. Our HIPAA -compliant processes, encrypted connectivity infrastructure, and experience in privacy and data security can help you strengthen compliance with state and federal regulations.
• Confidentiality. Customer and patient data is scrupulously maintained.
• Defined service levels— your assurance of quality, accuracy, and cost controls.