Leveraging Emerging Technologies for Business Optimization and Elevated
Patient Experiences
A team of seasoned unconsultants dedicated to guiding national and regional health plans navigate through complex problems and facilitate the implementation of simple and effective healthcare payer solutions.
Our unconsultants approach prioritizes collaboration and unconventional perspective, working alongside you as a cohesive team. We bridge the gap between Business and IT with proven industry expertise in delivering scalable, business-driven technology and process solutions. We provide healthcare payer solutions that harness emerging technologies to optimize businesses and improve patient outcomes and experiences.
Ensuring appropriate and efficient use of medically necessary healthcare resources, services, and treatments while optimizing administrative processes and costs.
Our comprehensive approach with custom healthcare payer solutions enables health plans to enhance operations and have fiscal oversight of their members’ services.
Automate and auto-populate the database of members to efficiently retrieve relevant information and details across various systems, eliminating manual data retrieval and streamlining the process for customer advocates and their teams.
A decision engine that analyzes and determines the auto-approval or need for further review of service requests, expediting the decision-making process and addressing potential data gaps upfront to optimize efficiency and minimize the involvement of high-cost resources.
Within our healthcare payer solutions, our solution aggregates data and access control, allowing users to access specific data sets that pertain to their role, thereby increasing the accuracy of decision-making.
Artificial Intelligence presents a natural fit where outdated human decisions can be automated through ML models trained on established criteria. This scalable and agile approach reduces administrative costs and optimizes workflow to improve member satisfaction.
Delivering patient-centered quality care by leveraging data insights to ensure that patients/members receive appropriate and timely care to prevent their healthcare costs from escalating.
Our comprehensive solution manages and determines the most suitable next steps, personalizing care delivery, cost containment, and enhancing patient outcomes across the healthcare continuum.
Utilizing valuable insights from large amounts of data to assist healthcare professionals in timely intervention and personalized care, improving efficiency, and enhancing communication to prevent further complications.
Prioritizing health conditions and facilitating the routing of patients to appropriate interventions are crucial components of our case management solutions. Our comprehensive approach eliminates the need to outsource for specialized services by orchestrating and coordinating case management efforts, guiding decision-making, and optimizing patient routing. This includes seamless integration with payer enrollment services for a streamlined and efficient healthcare management process.
Leveraging the power of AI to generate risk scores and recommend timely intervention and prioritize resources to improve patient engagement, reduce unnecessary utilization, and improved outcomes.
Enabling claims matching process through integrating and aligning authorization and claims data to support payment accuracy is a key feature of our healthcare payer solutions. This ensures that healthcare organizations are accurately paying for the services that have been authorized.
Our comprehensive healthcare payer solutions perform checks and balances to validate claims, bridging the gap between utilization management and claims systems.
Automating claims processing by streamlining workflows and creating configurable exception handling based on organization’s unique needs. Thus, increases the efficiency of adjudicating claims by simplifying exception handling process and only showing relevant information.
Provide custom screens for financial services unit to identify and address pending claims, enhancing decision-making efficiency.
Validating claim data against utilization management systems/authorization systems for accuracy and consistency, eliminating manual effort and human error.
Automating clinical decision-making processes to provide nimble and agile capabilities to clinicians in specialty chronic condition management Oncology, Diabetes, etc. Eliminating the complexity and challenges associated with rules engine configuration by creating a single and reliable source of truth for medical necessity.
The clinical Decision Support system as a consolidated source ensures consistency and accuracy across any healthcare organization, streamlining and simplifying the authorization process at scale.
Enabling authorization process to manage multiple regimens and approval criteria across diverse health plans, ensuring accuracy and variation evaluation prior to making a decision.
Enabling initial shell authorization with collected data and running it against member benefit eligibility and other decision factors.
Streamlining workflow process for regimens approval by cross-checking them against preapproved criteria of each health plan, taking traditional treatment plans, drug approvals, and alternatives into consideration prior to automating a decision.
Oversight of workflow to verify regimen variation for the authorization process. The tool provided a mechanism to have an audit of changes and impact across the organization.
Ensuring appropriate and efficient use of medically necessary healthcare resources, services, and treatments while optimizing administrative processes and costs.
Our comprehensive approach with custom healthcare payer solutions enables health plans to enhance operations and have fiscal oversight of their members’ services.
Delivering patient-centered quality care by leveraging data insights to ensure that patients/members receive appropriate and timely care to prevent their healthcare costs from escalating.
Our comprehensive solution manages and determines the most suitable next steps, personalizing care delivery, cost containment, and enhancing patient outcomes across the healthcare continuum.
Enabling claims matching process through integrating and aligning authorization and claims data to support payment accuracy is a key feature of our healthcare payer solutions. This ensures that healthcare organizations are accurately paying for the services that have been authorized.
Our comprehensive healthcare payer solutions perform checks and balances to validate claims, bridging the gap between utilization management and claims systems.
Automating clinical decision-making processes to provide nimble and agile capabilities to clinicians in specialty chronic condition management Oncology, Diabetes, etc. Eliminating the complexity and challenges associated with rules engine configuration by creating a single and reliable source of truth for medical necessity.
The clinical Decision Support system as a consolidated source ensures consistency and accuracy across any healthcare organization, streamlining and simplifying the authorization process at scale.
Developed a pre-authorization-to-claims matching solution to streamline the processes for commercial, Medicare, and Medicaid plans. Our solution lowered costs and improved customer satisfaction for the payer's clients.
Launched a Care Management product for employers, individuals, families, and Medicare/Medicaid plans, and managed the clinical components of planning, execution, and operational readiness, ensuring a successful go-live and stabilization.
Delivered a custom Utilization Management solution for Medicare and Medicaid programs, seamlessly migrating users across multiple sites without disrupting customer service.
Implemented a strategic Change Management program, migrating 2,500+ clinical staff across multiple sites. The solution serves as a blueprint for future processes and technology updates.
