Business Process Solutions for Healthcare Payers

Redirect resources to business-building core capabilities— take advantage of cost-effective, high-quality Perot Systems® Healthcare Payers Business Process Solutions.

Challenge
For healthcare payers, 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
Perot Systems can help, with outsourced transaction processing for claims administration, adjudication, and member services. You’ll benefit from our low-cost infrastructure, economies of scale, quality assurances, and best-practice methodologies and proven technologies for workflow and knowledge management.

Our thorough expertise in healthcare provider claims billing and management processes positions us on the leading edge of process management—and gives you the edge over your competition.

Our healthcare payer services include:

• 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 Perot Systems® Healthcare Payers Business Process Solutions, your organization can enjoy:

• Easy transition, as 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.
• Higher compliance. Our HIPAA -compliant processes, encrypted connectivity infrastructure, and experience in privacy and data security can help you ensure compliance with state and federal regulations.
• Confidentiality. Customer and patient data is scrupulously maintained.
• Defined service levels to help you control costs while enhancing the quality and accuracy of transactions