Payer Services

PAYER SERVICES

Our innovative payer solutions enable you to derive operational excellence and maximize customer service for healthy patient experience and relationship.

Enhancing customer communication, reducing the costs and streamlining the processes are key concerns for healthcare payers..

Healthcare payers are changing their business approach. They are shifting focus toward managed health, increased regulatory compliance and greater investment in technology, while optimizing costs. Healthcare exchanges are not only driving growth for payers but also empowering consumers to make their own choices. These trends have prompted the payer community to adopt a more customer-centric approach through collaborative partnerships.

With our diverse portfolio of end-to-end offerings, payers can expect to achieve process excellence, agility and flexibility in their business processes. We provide the right mix of services and tech-enabled solutions to meet the challenges in the healthcare payer sector.

Member Enrollment

Provider Data Management

Claims Adjudication

Claims Repricing

Risk Adjustment

HEDIS Abstraction

RADV Audit

Quality Performance Reporting

Efficiencies, outcomes, and growth drive business imperatives for payers

A complex and changing healthcare environment challenges those goals. Managing high-risk and rising-risk patients’ care continuum, automation, and reducing rates of human errors are keys to reigning in expenses.

AnnexMed has been delivering extraordinary outcomes for payers. With the move towards value-based payment structures, payers are focusing on developing new business models, enhancing IT capabilities, building a better care coordination infrastructure, and lowering costs.

Our certified healthcare professionals provide unparalleled expertise and proven results across the HIM coding solutions

Member Enrollment

Our member enrollment services reduce the administrative burden and cost to support member enrollment processes. Our eligibility and benefits configuration, backed by our knowledge-based platform, addresses the industry problem of inaccurate benefits configuration. This leads to a reduction in improper claim payments and a decrease in appeals and grievances.

Provider Data Management

Our provider network data management process mitigates increased labor costs due to the enhanced complexity of provider payment arrangements and provider network contracts. Efficient provider credentialing services avoid incorrect contract rates in claims.

Claims Adjudication

Our paper to EDI conversion, combined with repricing and our rule-based auto adjudication support service, helps payer clients further cut down on cost. Our deep understanding and evaluation methodology of medical claims and contracts enable payers to save money through identification of overpaid claims.

Claims Repricing

We manage the administrative complexities of claims re-pricing on your behalf, receiving the paper or electronic claims, making the adjustments ourselves according to your established provider discounts, and forwarding them to you for further processing.

Risk Adjustment

Our solutions – retrospective chart retrieval and review, risk adjustment data validation (RADV) – support the effort to capture missing risk adjusting diagnoses and ensure members are appropriately risk adjusted. Our proven service delivery model takes chart review to the highest level, ensuring timeless, quality, accurate documentation and optimal results.

HEDIS Abstraction

Our HIPAA-compliant HEDIS audit and coding services help insurers meet NCQA’s quality goals and healthcare practices maximize HEDIS reimbursement. We are well-equipped to meet your complex coding and data abstraction requirements.

RADV Audit

We take a client-centered approach to Mock RADV Audit services. We offer plan-specific audit analysis reporting, calculations of potential payment error, and recommendations for trouble areas identified during the mock audit. We mirror CMS’s RADV audit process, giving your program a reliable results.

Quality Performance Reporting

AnnexMed quality management offers insights that enable health plans to understand performance on quality measures, monitor pay-for-performance, achieve VBP4P and HEDIS® compliance, and ultimately improve quality care for their members.

Providing Ensured Results and Predictable Costs for Healthcare Payers

AnnexMed’s healthcare capabilities enable payers to improve profitability, using flexible, nimble and responsive solutions. Our proven solutions and delivery models have helped top healthcare clients address their most demanding challenges.

Our diverse range of services and years of experience in dealing with both providers and payers allows us to streamline workflow for peak financial performance. Cutting-edge technology, professional acumen and vast experience are deployed to reduce transaction costs and deliver high quality services.

Service Highlights

AnnexMed offers a wide range of payer services and solutions covering Pre-Adjudication, Adjudication, Post Adjudication, Medicare Risk Adjustment, Data Management for major HMO, PPO and Indemnity to government sponsored plans like Medicare, Medicaid, Workers’ Compensation etc.

  • Over 95%+ accuracy
  • Meeting and exceeding SLAs
  • Reduction in turn-around-time
  • Delivering productivity, savings, and quality
  • Over 100 certified Nurse Practitioners and clinical coders
  • Flexible engagement models to reduce total cost of operations
  • Process evaluation (based on complexity, criticality, cost and risk)
  • Scalability with dedicated delivery centers to manage businesses