Payor Services

Outsource2Experts is committed to providing the best claims management service. Outsource2Experts provides its clients with personalized service, timely and accurate claims administration and a full range of related support functions. Our tailored claims administration includes Medical, Prescription, Dental, Vision, and Disability.

Outsource2Experts takes a comprehensive, well-structured, and expertly managed approach to every outsourced process we handle. Our professionals communicate clearly with all parties involved and continuously monitor and manage all of the issues that can affect the cost of a program. Through our experience in many different industries and in all aspects of business process outsourcing, we have developed an exemplary set of best practices for the day-to-day conduct of our business. They guide not only how we work with our clients, but also with all others involved. The result is cohesive, consistent service delivery from the first step in a process through ongoing management of a program.

Business Process Outsourcing allows firms to boost productivity, improve customer services, and most importantly, devote their resources to pursuing the company's primary vision. These factors have elevated outsourcing to much more than a cost- cutting tactic. BPO is now a strategic initiative that is driving the direction of the enterprise and the global economy.

Outsource2Experts has become a dominant force in the claims management industry by offering a single outsourcing solution for comprehensive, cutting-edge claims and administration services. Outsource2Experts works with clients to minimize their claims and loss costs and to maximize bottom line performance. Our commitment is to provide the highest level of customer service during settlement of claims.

Not only are our claim professionals thoroughly trained in best practices, they are knowledgeable and experienced in managing all aspects of claims administration. They focus on achieving uniformly high settlement quality, outstanding loss results on each claim, and positive financial outcomes for every client. Quality, consistency, and bottom-line performance are the hallmarks of the full range of our service capabilities.

Health Plans face increasingly complicated medical claims-handling processes—at the same time encountering rising healthcare costs and declining per-case prices. Outsource2Experts is focused on one goal: improving adjudication rates by guaranteeing data quality, decreasing turnaround times and significantly reducing costs associated with claim handling.

From claim receipt and pre-conversion cleaning to re-pricing and document management—all with state-of-the-art business process management technologies for maximized operational control and reporting— Outsource2Experts offers a medical claim process management technology solution even for the most complex health plans.

Why outsource your claims to Outsource2Experts?

Quality, efficiency and technology are Key in health insurance claims processing. That’s why so many clients rely on Outsource2Experts’ Claims Services Division for outsourcing support.
Whether it is claim imaging and OCR claims data capture, full claims adjudication processing or system conversion support, we have the solution for your claims processing needs.
Outsource your transaction processing for claims administration, adjudication and membership services and pay claims faster, more accurately and at a lower cost and reduce internal administrative expenses and increase profitability.
Services
Our clients are Third Party Administrators (TPA), Management Services Organizations (MSO) and Health Plans who gives highly individualized and personalized service to their clients. For them, responsiveness is critical. Growth is high for many of our TPA-clients who have earned the trust of their clients by ensuring compliance as the industry around them changes. MSO focus on providing excellent service and outstanding results to their IPA and Medical Group clients.

Outsource2Experts works closely with our TPA, MSO and Health Plan clients to provide Claims Support Services that meet their unique needs. Our Paper Claims-to-EDI Conversion Services are custom designed for each of our TPA, MSO and Health Plan clients who are over burdened by mountains of Paper Claims.
Simple and affordable, Outsource2Experts' turnkey solution for paper claims administration cuts claims processing costs, improves accuracy of paper claims adjudication, enhances productivity of claims examiners and archives paper claims for easy and convenient access anytime through an intuitive and secure web interface.
Our Healthcare Payor Services includes:
* Claims Entry – CMS-1500, UB-92 and ADA Dental Forms
* Member Enrollment Services
* Provider Data Services
* Authorization Support Services
* Claims Adjudication
* Claims Repricing
* Customer Care Support
Benefits
• Eliminates handling of Paper Claims
• Cuts Paper Claims Processing Costs by 40%-50%
• Archive, Search, and easily retrieve paper claims at the click of a mouse
• Improves accuracy of paper claims adjudication
• Improves HIPAA and CMS compliance for paper claims tracking
• Reduces storage costs
• Improves turnaround times for processing
Overview
Outsource2Experts provides Paper Claims-to-EDI Conversion Services for Third Party Administrators (TPA), Management Services Organizations (MSO) and Health Plans who are overburdened by mountains of Paper Claims.
Electronic Claims that go through a Clearinghouse service can often account for 50% of CMS-1500s and UB-92s that our clients receive. Outsource2Experts’ Paper Claims-to-EDI Conversion Services enables Claims Administration Departments to eliminate paper and populate their Adjudication System without requiring manual data entry at their end.

Claims Entry – CMS-1500, UB-92 and ADA Dental Forms
Claims are scanned by your team and immediately uploaded to Outsource2Experts for indexing by such parameters as Patient Name, Date of Birth, Date of Service, Payer, Provider, Claim Amount, unique DCN Number, etc. Claims and attachment images are retrieved within seconds by utilizing any of the above parameters by multiple users simultaneously.
Outsource2Experts converts paper CMS-1500 and UB-92 claims into a standard EDI stream (NSF 2.0 or 837 format), similar to that which claims departments receive for electronic claims from Providers through their clearinghouse.
Member Enrollment Services
Health Plans which are growing rapidly have to deal with constantly adding and updating their Enrollments databases. Many plans take as much as 30-45 days before a new member can be enrolled. Additionally the enrollment paper forms need to be entered into the core claims system and members need to be removed on a timely basis for accurate payment of claims.
Outsource2Experts converts the Membership Enrollment forms and provides the electronic file, thereby eliminating manual data entry and reduces errors significantly at your end. Since the members are enrolled quickly, you can start collecting premium sooner!
Convert Paper Enrollments into an Electronic Format
Outsource2Experts provides you with an electronic image of enrollment forms as well as a database of all the fields from that form to populate your Core Claims System easily. Outsource2Experts indexes and provides the electronic images of all Enrollment Forms and related attachments received.
Handle changes and Member Terminations
Outsource2Experts’ Enrollments services also processes all changes to the Enrollments forms and Member Terminations elegantly without using any additional staff at your end.
Provider Data Services
Outsource2Experts’ Provider Data Services accurately sets up new Providers, Provider Groups, and Facilities into your Claims Adjudication System. We also manage any and all changes and updates to the Provider Information, so that claims are accurately processed.
• Add and maintain pertinent information into your claims adjudication system from the provider.
• Review W9s and supporting documentation and enter required information to set up providers accurately into claims system
• Setup Provider Groups and Facilities in addition to Individual Providers
• Manage several provider attributes such as indicative sections, multiple locations, addresses, payment information, tax information, out-of-network and additional details.
• Modify missing or incorrect provider information so that pended claims are released on a timely basis from your system.
• Removal or termination of obsolete providers
Authorization Support Services
Are the Authorizations forms received by claims department not being entered on timely basis and claims incorrectly denied or paid on the received claims because of improperly entered Authorizations *
Outsource2Experts’ Authorizations Support Services enables your departments to eliminate paper and populate their Claims Adjudication Systems with Authorization forms received without requiring manual data entry at their end.
• Outsource2Experts converts paper authorizations and attachments, and stores them for easy retrieval at any time.
• Accurately processes your authorizations using the rules and enters them into your Claims Adjudication Systems such as EZ-CAP, IDX, HealthTrio, LuminX and others.
Claims Adjudication
If the claims are pended for longer durations which increases risk of your organization for health-plan non-compliance, increased support call volume, and lower customer satisfaction.
Outsource2Experts brings you a whole variety of health insurance claims processing solutions to help you manage your claims efficiently. Outsource2Experts brings vast experience of working with healthcare payer claims systems across a variety of technologies.
Our Claims Adjudication services utilize claims professionals who are trained on multiple adjudication platforms and plan designs. Our Adjudicators have knowledge of medical terminology and also go through client specific training to learn your insurance plans, systems and claim types.
• Accurately resolve pended claims using your guidelines, state and federal regulations, and using specific health plan criteria.
• Review attachments and documentation which are received with the claim and utilize that information for adjudication.
• Correct invalid information and/or enter missing information, so that pended claims are released on a timely basis.

Claims Repricing

Outsource2Experts offers health care claim repricing services to insurance carriers and self-funded employer groups. We reprice provider bills according to pre-negotiated fee schedules and forward original bills and repricing cover sheets on to carriers and self funded groups. An integrated blend of people, technology, and intelligent processes, our claims processing system is one of the most sophisticated and efficient in the industry. As a result, clients realize significant cost savings while providing their employees access to prompt, accurate and convenient service.
Customer Care Support
Cost savings, greater flexibility, consistency and reliability of services, quality of the customer experience and customization of processes is what Outsource2Experts offers to its clients. We understand customer support and back-office processing services prevalent in the global insurance industry and services insurance providers, carriers, brokers and administrators.

Our project management methodology along with the efforts taken to understand processes has provided immediate benefits to clients. Outsource2Experts has experience in delivery of multiple complex processes involving decision-making within the insurance domain and provides support for both transaction and voice processes.