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.

Provider Data Management

Member Enrollment

Claims Adjudication

Claims Repricing

Risk Adjustment

HEDIS Abstraction

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

Provider Data Management

Save your time and money associated with inaccurate or out-of-date provider data by leveraging our Provider Data Management and Credentialing services.

Improve your data accuracy, provider & member satisfaction by using our solutions that include secure data management and skilled personnel

Member Enrollment

Manage the sporadic volumes during the open enrollment season without compromising on your turn around time by having us support you.

Utilize our eligibility and benefits configuration, backed by a knowledge-based platform, addresses the industry problem of inaccurate benefits configuration.

Claims Adjudication

Our deep understanding and evaluation methodology of medical claims and contracts enable payers to save money through identification of overpaid claims.

With our expertise, your enterprise will experience a dramatic improvement in payment accuracy and avoid incorrect denials and reduces the time for customer support.

Claims Repricing

Our repricing solution helps payers to increase adjudication; first pass rates, reduce cost and enhance overall consumer service.

Ensure the claims processing with faster settlements & lower processing costs with our skilled team, acquainted to work with multiple platforms.

Risk Adjustment

Our comprehensive HCC Risk Adjustment services are designed to ensure CMS compliance, the accuracy of coding of your medical records and sustainable growth.

Our coders are Certified Clinical Coders (CRC) and well-trained on the Claims Data Validation, Part C (HCC) and Part D (Rx HCC) Coding, who are capable of highlighting of key coding and documentation errors for provider education.

HEDIS Abstraction

Our HIPAA-compliant HEDIS audit and coding services help insurers meet NCQA’s quality goals and healthcare practices maximize HEDIS reimbursement.

Our solutions 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
  • Exceeding customer expectation
  • Reduction in turn-around-time
  • Delivering productivity and cost savings
  • Over 100 certified clinical coders
  • Flexible models to reduce the cost of operations
  • Process evaluation and improvement
  • Scalability with exclusive delivery centers