ACO Workflow Solutions
Stratify high-risk population using an extensive ACO system that enables providers to deliver coordinated care for chronically ill patients. Getting the right value-based healthcare solutions simplifies ACO’s workflow and anticipate any possible drawbacks. Ensure to optimize the reliable platform in order to prevent unnecessary duplication of services and medical errors. It is the best way to better manage data, enhance patient care, meet health goals, maximize performance, and render the service in a timely manner.
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Value Added:
Business Process as a Service (BPaaS) - Effective Resource Alignment
BPaaS, or Business Process as a Service, is a solution offered by MedVision that enables organizations to make better use of their resources, whether they are just beginning or expanding. BPaaS alleviates the burdensome duties organizations have internally as they innovate, restructure, or seek to better manage continuing operational expenses.
BPaaS
Task Management Services
Membership
Encounter processing and reporting to health insurance – ensuring network performance timeliness standards are fulfilled
Encounters
Encounter processing and insurance submission — ensuring network performance timeliness requirements are met
Providers
Loading and updating provider information, together with contract alignments, to guarantee accurate provider reimbursement.
Health Plans
Configuration of existing or new health plan agreements, payment and carve-out structures or processes with network and out-of-network provider organizations, resulting in an unified upstream and downstream structure.
Reporting
Generating timely utilization, authorization, and claims report formats required by health plan partners – assuring compliance with important delegated processes
Workflow
Developing and maintaining each rule that influences the routing or approval, denial, and pending procedures of referrals, authorizations, and claims inside the delegated value-based organization.
BPaaS
ACO Workflow Operations Solutions
Credentialing
Full provider profiles and triggers to keep data updated – compliance with all delegated authorities, updating through primary or secondary source verifications
Referrals Processing
Manage the whole use cycle based on accepted medical criteria, making the authorization process easier as per organization guidelines.
Claims Administration
Claims from providers and facilities are processed and decided on, and payment and distribution are made.
Capitation
Manage capitation payments and provider reports that go out. Trends in how health plans are used can help find network leaks.
Contract Negotiation
Executive teams with experience analyzing contracts and frameworks for all network stakeholders, including plans, providers, specialists, facilities, and additional services. They work for you to help you make more money.
Call Center Operations
Full-cycle Customer Service department with the ability to log all incoming questions, send them to the right people, and integrate with appropriate department structures, like claims and referrals, for faster call solutions and resolutions.
