Claims Processing

Claims Data Entry

While most of the claims today come through EDI, a good % of claims still continue to be submitted in manual formats, or the claim data needs to be scrubbed and entered into the claims administration system to validate the information, and adjudicate the claim.

As a payer business process services provider, Atom Healthcare provides claims data entry resources who process claims with high degree of accuracy while adhering to turnaround times service levels.

Pended Claims Resolution

Investigating and resolving a pended claim can be a complex and resource-intensive task. While many of the reasons claims get pended are common to all health plans, there are quite a few reasons that are unique to the health plan’s processes and systems. While this means that resources processing pended claims need to possess strong knowledge of the health plan’s processes and systems, often health plans do not have the resources to resolve and prevent future pended claims issues.

Atom Healthcare helps health plans with resources to process backlogged pended claims volumes. We categorize each issue, understand the root cause, and work with our clients to improve auto-adjudication rates, with a focus on reducing operational costs and improving turnaround times.

Claims Repricing

The emphasis on managed care necessitates that health plans reprice many standard codes to correspond with their focus on decreasing costs and improving quality of care. Unfortunately, reimbursement methodologies are complex and many health plans still struggle with the process of repricing their in-network and out-of-network provider contracts.

Atom Healthcare enables health plans to put in place claims repricing processes to ensure their claims are correctly adjusted and done so in a timely manner. We provide knowledgeable resources to help health plans save costs and improve turnaround time by contacting providers to sign-off on discounts, and reduce appeal times.

Claims Adjudication

Inefficient claims processes can mean huge claims backlog and, consequently, lead to member and provider dissatisfaction.

Atom Healthcare’s deploys a team of claims adjudication specialist to help health plans reduce their claims inventory and the total costs to process. We can support the entire claims process through claims data entry, adjudication, and payments. We work with our clients to understand the root cause of claims falling out of auto adjudication, and improve the business rules on the platform to improve auto-adjudication rates.

Benefits

  • Quick turnaround time. Improve the time taken to adjudicate the claim

  • Improve Accuracy. Reduce errors through robust quality assurance processes and seasoned claims adjudicators

  • Strong Governance processes. Our robust governance processes ensure that you are always in control with detailed reports on claims inventory, and service level commitments.

  • Reduces costs associated with claims processing by as much as 30-40% through our deep global delivery model


Contact Us for Claims Processing Services

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